There are going to be a lot of factors that may affect your medical billing and reimbursement in 2013. Expect it to be a year full of changes. The following are some of the biggest issues that we are going to see in the next twelve months.
- Medicare: It’s been 10 years since we’ve seen the government announce a raise in Medicare rates in conjunction with the release of a Medicare Physician Fee Schedule (MPFS), but history has not numbed us to the shock of seeing a 26.5 percent across-the-board decrease in physician reimbursement.
However, in a press release, CMS revealed its dedication to try to reverse the very cuts that it just announced, declaring: “The Administration is committed to… ensuring that these payment cuts do not take effect.” Under extreme pressure to enhance access for seniors, CMS is apparently just as frustrated as physicians, but for now the agency’s hands are tied.
Unfortunately, Medicare access and physician reimbursement are two of the many issues that Congress and the President must address to avoid plummeting over the “fiscal cliff” of mandated federal spending cuts in January. Don’t expect to learn the fate of Medicare reimbursement in 2013 until sometime in mid-January – possibly later.
- RVUs: In addition to the massive reimbursement cuts forced by the conversion factor reduction, several specialties face significant reimbursement declines for another reason: reductions in the relative value units (RVUs) associated with CPT® codes those specialists frequently use. On the flip side, primary care specialties will see increases of three percent or more in 2013, thanks to upward revisions in the RVUs of many services they typically perform.
However, primary care physicians will also benefit from a measure that temporarily provides parity between Medicaid and Medicare rates. Taking effect January 1, 2013, and continuing for the next 24 months, primary care physicians and other eligible health care professionals accepting Medicaid will be guaranteed to receive rates at or equal to Medicare. The parity will be limited to evaluation and management (E/M) services and vaccines. Click here for the November 6, 2012 announcement that details the rate parity.
- Payer Incentives: The reimbursement landscape for 2013 is also influenced by ongoing incentive programs for physicians and other eligible providers to encourage technology adoption.
Medicare’s eRx program continues in 2013 with a requirement to generate and electronically transmit 10 prescriptions by mid-year to avoid a reimbursement penalty. If you missed the June 30, 2012, deadline to do so, you may still have the opportunity to avoid the penalty – a 1.5 percent reduction applied to all Medicare reimbursement throughout 2013.
Another popular incentive program sponsored by the federal government, the Physician Quality Reporting System (PQRS), should get a great deal more attention next year. That’s because avoiding the imposition of PQRS penalties in 2015 will be based on successful PQRS performance in 2013.
More information has been released about the value-based modifier (VBM), which will be implemented on a widespread basis in 2017 but is already being fervently discussed. Don’t think of this modifier as one that is attached to a CPT® code. The VBM is not a coding convention; it’s a concept that will modify payment based on the “value” that the government deems appropriate to measure.
- Patient-centered Medical Homes: Medical homes are also a likely hot topic for many physicians and other health care professionals going into 2013. Several organizations, including the National Committee for Quality Assurance (NCQA) and the Joint Commission, recognize practices as medical homes. In addition to validating the high performance of medical practices, recognition as a medical home is poised to become an important revenue source for practices, especially with the majority of states having one or more private payers that recognize medical homes with enhanced reimbursements. The medical home concept will likely spread further once the NCQA releases the details of a recognition program for specialty practices, expected in February 2013, considered to be an integral component of the patient-centered medical home “neighborhood.”
- ICD-10: As if preparing for big changes in Medicare reimbursement and understanding myriad other changes in the MPFS isn’t enough, 2013 will also be the year to get serious about preparing for new diagnosis codes. After several fits and starts, ICD-10 will be implemented on October 1, 2014. With just more than a year to prepare for the inevitable, it is critical to learn this new and much more complex system. You’d be wise to also determine how your vendors plan to support it – and your efforts to adopt it.
- Meaningful Use: In addition to preparing for ICD-10, be sure to assess your readiness for Stage Two of Meaningful Use, which will commence on January 1, 2014. The program continues the core/menu focus introduced in Stage One, but now there will be 17 core criteria plus three more to select from a menu of six. Two of the criteria required for Stage Two have sparked controversy among the medical practice community. One criterion is that five percent of your patients must download, view or transmit their health information. Another criterion calls for five percent of your patients to send you a secure electronic message. In other words, you’ll be held accountable for hitting electronic communication targets that you must ask your patients to do.
Once again, the old adage ‘change is the only constant’ seems to be truer than ever. 2013 will bring new challenges, but high performing practices have the vision to try and turn new requirements and other hurdles into opportunities for enhanced patient access and better revenue.
To find out more about these issues and their impact on your reimbursement, join me for a free webinar, Getting Paid in 2013, on Thursday, December 13. I’ll discuss all of these topics and how to maintain your fiscal health into 2013. Register here.
About the author: Elizabeth Woodcock, MBA, FACMPE, CPC is a professional speaker, trainer and author specializing in medical practice management. She has focused on medical practice operations and revenue cycle management for more than 20 years.