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CMS Announces Update on Implementation of 2013 Medicare Physician Fee Schedule

Thursday, January 03, 2013

The recently enacted "cliff" package, the "American Taxpayer Relief Act of 2012," averts a 26.5-percent Sustainable Growth Rate (SGR) cut to Medicare payments for physician services and instead provides for a zero percent SGR update for physician services provided from January 1, 2013, through December 31, 2013.  In response to the law, CMS released the following statement:

"The Centers for Medicare & Medicaid Services (CMS) is currently revising the 2013 Medicare Physician Fee Schedule (MPFS) to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November.

In order to allow sufficient time to develop, test, and implement the revised MPFS, Medicare claims administration contractors may hold MPFS claims with January 2013 dates of service for up to 10 business days (i.e., through January 15, 2013).  We expect these claims to be released into processing no later than January 16, 2013.  The claim hold should have minimal impact on physician/practitioner cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt.  Claims with dates of service prior to January 1, 2013, are unaffected.  Medicare claims administration contractors will be posting the MPFS payment rates on their websites no later than January 23, 2013.

The 2013 Annual Participation Enrollment Program allowed eligible physicians, practitioners, and suppliers an opportunity to change their participation status by December 31, 2012.  Given the new legislation, CMS is extending the 2013 annual participation enrollment period through February 15, 2013.  Therefore, participation elections and withdrawals must be post-marked on and before February 15, 2013.  The effective date for any participation status changes elected by providers during the extension remains January 1, 2013."


ASA will post updated locale-specific anesthesia conversion factors as they are made available.

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