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CMS Releases FY2013 Proposed Physician Fee Schedule; New Care Coordination Payment

Posted on 7/9/2012 by NTOCC ® in Public Policy Updates

On July 6th, the Centers for Medicare and Medicaid Services (CMS) published its proposed rule that would update payment rates for services furnished by physicians and non-physician practitioners under the Medicare Physician Fee Schedule for 2013. The rule also includes several proposed changes to quality related programs impacting physicians, including the Physician Quality Reporting System; the Electronic Prescribing Incentive Program; and the physician value-based payment modifier.

Of particular interest to NTOCC, is that for the first time, CMS is proposing to "pay for the care required to help a patient transition back to the community following a discharge from a hospital or nursing facility." Specifically, the proposed rule would create a new billing code that defines transitional care management services.

As detailed in the proposed rule, many of the components of these services align with NTOCC’s seven essential elements including:

  • Assuming responsibility for the beneficiary’s care without a gap;
  • Establishing or adjusting a plan of care;
  • Communication with the beneficiary or caregiver, including education based on plan of care;
  • An assessment of the patient’s or caregiver’s understanding of the medication regime;
  • Communication with the other health care professionals who will assume care of the beneficiary post-discharge;
  • Assistance in scheduling any required follow-up with community providers and services.

Primary care or community physicians would be able to bill for those services furnished to patients following a stay in the hospital or skilled nursing facility to ensure continuity of care. This payment would be allowed once in the 30 days following discharge for patients "whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions..." as defined in the current Evaluation and Management Guidelines.

CMS will accept comments on the proposed rule until September 4, 2012, and will respond to them in a final rule with comment period to be issued by November 1, 2012. For more information please, see the attached fact sheets. To view the proposed rule, please click here.

In addition, this morning CMS announced that 89 new Accountable Care Organizations (ACOs) have been selected as of July 1st to serve Medicare beneficiaries in 40 states and Washington, D.C., bringing the total list of ACOs to 154. For more information, including a list of the new ACOs, please click here.