Recently, CMS has proposed family practice coding guidelines that increases family physicians pay by 7% and that of other practitioners providing primary care services by 3-5%. This is part of the rule that will upgrade the policies related to payment and rates under MPFS for the year 2013. According to it, Medicare pays millions of physicians as well as non-physicians who actively provide healthcare services to beneficiaries of Medicare. CMS is making an ongoing effort to align program requirements across practices with the goal of creating one set of universal measures to be used in all programs.
This increase for family physicians is a result of the policy by the administration to encourage care that is focused on quality and is patient centric. CMS will pay the required amount that is needed to help a patient smoothly settle back in the community after getting released from the hospital. CMS will pay to the physician of the patient to coordinate the patient’s care in the 30 days.
The Value Modifier used in medical coding & billing that was included in the Affordable Care Act will be implemented as well and will provide various choices to physicians on how to participate. Based on the quality of care that is given to a beneficiary of Medicare, the Value Modifier determines the payments. The rule also gives the opportunity for physicians or groups to choose how the Value Modifier can be calculated based on their participation in the PQRS/PQRI. Physicians or groups that want to have payment adjusted with their performance based on the value modifier has a rule according to which high quality and low cost groups will receive more payment and vice versa.
Some other points included in the proposed rule are:
- Additional Medicare preventive services to be included in the existing list that can be provided with the help of an interactive telecommunications system.
- DME to be a direct requirement to get paid for certain Medicare DME items that are costly.
- MPPR policy to be applied to the technical component of the subsequent diagnostic service of cardiovascular or ophthalmology provided by the same doctor to one particular patient on the same day.
- Collection of data based on patient function to improvise Medicare pay for physical, occupational, speech language and pathology services.
- Comments from public regarding advanced diagnostic molecular pathology services payment.
- Payment by Medicare to physicians and non-physicians following Medicare for portable x-ray services.
- Guidelines as to when Medicare payment will be made for interventional pain management services administered by CRNAs
