2013 Medicare Physician Fee Schedule Update

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Medicare Physician Fee Schedule Update – December 20, 2012

The 27% reduction of fees under the current law for the 2013 Medicare Physician Fee Schedule is scheduled to take effect on January 1, 2013. The Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2012 are not affected by the 2013 payment cut and will be processed and paid by Medicare under normal procedures and time frames.

CMS has announced that they are disappointed that Congress has failed to pass a solution to eliminate the faulty sustainable growth rate (SGR) formula-driven cuts that will cause the 27% reduction in fees for 2013. Due to Congress’ inability to pass a solution to the SGR problem, CMS has announced that they must take steps to implement the negative update and further information will be forthcoming.

  1. Under current law, clean electronic claims are not paid sooner than 14 calendar days after the date of receipt.
  2. Under current law, clean paper claims are not paid sooner than 29 calendar days after the date of receipt.
  3. CMS will notify you on or before January 11, 2013 with more information about the status of Congressional action to avert the negative update.

Based on past performance, this notice means that CMS is looking at possibly holding claim payments depending on the status of Congressional action. If they believe Congress is close to a solution to negate the 27% reduction, claim payments may be held up so claims only have to be processed one time. Otherwise, claims will be processed and paid with the 27% reduction and then the payments will be adjusted at a later time. If your practice relies heavily on Medicare, you need to be prepared for the 27% reduction in fees if Congress fails or is unable to reach an agreement on the physician fee schedule adjustments  for 2013.

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