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CMS Releases 2013 Medicare Physician Fee Schedule Final Rule

November 2, 2012—The Centers for Medicare and Medicaid Services (CMS) Nov. 1 released its final rule on the Medicare 2013 Physician Fee Schedule. The rule includes several changes to the 2013 Physician Quality Reporting System (PQRS) and 2015 value-based modifier calculation, and it expands the number of PQRS group practice reporting options (GPRO) for large groups.

The rule also includes a negative reimbursement update to physician services of 26.5 percent starting Jan. 1, 2013. The negative update is due to sustainable growth rate (SGR), a statutory formula that requires reductions to physician updates if physician spending in aggregate exceed national targets.  However, since 2002, Congress consistently has prevented the negative updates from being enacted. Last month, the AAMC joined over 100 physician groups encouraging Congress to repeal the SGR and replace it with meaningful payment reforms [see Washington Highlights, Oct. 19]

With regard to the value modifier, the agency made several changes to the 2013 PQRS and 2015 value-based modifier calculation. In particular, the value modifier will now apply to groups of 100 or more eligible professionals (EPs), rather than the proposed 25.

CMS also expanded PQRS GPRO for large groups.  In the proposed rule, groups of 100 or more EPs could report only through the Web interface or using administrative claims. Now, large groups can submit via registries or, starting in 2014, through the electronic health record (EHR) group reporting option.

CMS also finalized a new post-discharge care management code that pays providers for care coordination that occurs outside of a face-to-face visit.  The regulation will be published in the Federal Register Nov. 25.


Mary Patton Wheatley, M.S.
Director, Health Care Affairs
Telephone: 202-862-6297

Jane Eilbacher
Policy and Regulatory Specialist
Telephone: 202-828-0896


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806