2013 Medicare Fee Schedule

Announcement on 2013 Medicare payment rates from the AMA Practice Management Alerts:


The American Taxpayer Relief Act of 2012 was signed into law Jan. 2, 2013. The new law averts the 26.5% Sustainable Growth Rate (SGR) cut for all of 2013 and the 2% sequester for the next two months. It also extends the work Geographic Practice Cost Index (GPCI) floor for a year. Yesterday, the Centers for Medicare and Medicaid Services (CMS) released an announcement regarding updated 2013 Medicare payment amounts, claims processing, and reopening of the participation enrollment period.

Some carriers are not expected to post the new rates on their websites until at least next week and possibly later. The 2013 fee schedule amounts you received from your carrier in November include both the SGR and GPCI reductions, and thus significantly understate the current Medicare fee schedule.

In the meantime, some practices are asking what they should charge. By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount. In addition, most commercial health insurer physician contracts contain language that similarly sets the billed charge as the cap on payment. Thus, physicians who accept assignment should review their retail fee schedules and update them to reflect their current practice costs before they bill Medicare in 2013. Access AMA's “Defensible fee schedule” toolkit to assist you with this effort. The AMA recommends physicians either defer submission of claims for 2013 dates of service until the new 2013 rates are published, or bill their updated retail rates.

In addition, due to relative value changes that will affect some 2013 payment amounts and limiting charges, for unassigned claims practices should probably wait to bill patients directly for cost-sharing amounts until the new 2013 rates are published. We will keep you updated when any additional guidance is received from CMS.

[Posted January 4, 2013]

To view or sign up for AMA Practice Management Alerts visit their website.