Practice Management Alert

Plus, start getting prior authorization for Highmark patients for certain therapy services.

In early July, the CMS announced a proposed rule that would update the Medicare Physician Fee Schedule (MPFS) reimbursement rates for 2013. CMS says the rule would result in nearly a 7 percent payment increase for family practitioners and other primary care providers an increase of 3 to 5 percent.

"The 7 percent increase for family physicians comes from a proposal that continues the Administration's policies to promote high quality, patient-centered care," according to the CMS press release. "For CY 2013, CMS is proposing for the first time to explicitly pay for the care required to help a patient transition back to the community following a discharge from a hospital or nursing facility. The proposal calls for CMS to make a separate payment to a patient's community physician or practitioner to coordinate the patient's care in the 30 days following a hospital or skilled nursing facility stay."

Just as has been the case since 2002, CMS also projects a large decrease in the MPFS reimbursement rates under the Sustainable Growth Rate (SGR) methodology since the 2012 adjustment expires at the end of this year. Your payments are projected to go down 27 percent. Keep in mind, however, Congress has acted to avert the cuts every year since 2003.

Stay tuned to Medical Office Billing & Collections Alert for all the fee schedule payment news as the year continues.

In mid-June, Pittsburgh, Pa.-based Highmark announced that starting September 1, it will begin requiring prior authorization for some physical therapy, occupational therapy and manipulation services. The payer said in a press release that the new requirements are "designed to promote appropriate utilization of services and address growing customer concerns over unwarranted variations in the delivery of care that contributes to rising health care costs."

"This prior authorization requirement only takes effect after the first eight visits," said Virginia Calega, M.D., Highmark's vice president of medical management and policy in the press release. "If additional visits are medically necessary, we simply want to ensure there is a proper and appropriate treatment plan in place." According to Highmark, nearly two-thirds of members have their needs met and resolved within eight visits.