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Issue #201 - July 18, 2012


AAPC EdgeBlast

CMS' MPFS Proposed Rule Solves Longstanding Problems

The changes to policies and rates under the Center for Medicare & Medicaid Services' (CMS) proposed rule for the Medicare Physician Fee Schedule (MPFS) include sweeping fixes, and it allows for changes resulting from the Patient Protection and Affordable Care Act (ACA). Scheduled to be released in the Federal Register later this month, comments are due on the proposed rules Sept. 4.

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CMS Proposes Payment Policies and Rates for 2013

In rapid fire succession, the Centers for Medicare & Medicaid Services (CMS) released proposed rules in July that will dictate payment policies and reimbursement rates for health care providers in 2013 in several programs: Medicare Physicians Fee Schedule (MPFS), Outpatient Prospective Payment System (OPPS), home health, skilled nursing facilities (SNFs), and end-stage renal disease (ESRD).

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MPFS: Value Modifier Would Affect Payment

The proposed rule for 2013 Medicare Physician Fee Schedule (MPFS) policies and rates provides detail about the physician value-based payment modifier (value modifier) required under the Affordable Care Act.

The value modifier would adjust payments to individual physicians or groups of physicians based on the quality of care furnished to Medicare beneficiaries as compared to costs. The Centers for Medicare & Medicaid Services (CMS) will phase in the value modifier over three years, from 2015 to 2017.

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MPFS: 2013 Changes to Physician Quality Programs

The Centers for Medicare & Medicaid Services' (CMS') Medicare Physician Fee Schedule (MPFS) proposed rule for 2013 foretells possible changes to several quality reporting initiatives, including the Electronic Prescribing (eRx) Incentive Program, the Physician Quality Reporting System (PQRS), and the PQRS-Medicare EHR Incentive Pilot.

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Standards for EFT Final, Start January 2014

The Centers for Medicare & Medicaid Services (CMS) announced the interim final rule with comment period (IFC) published in January, which proposes the adoption of standards for electronic funds transfer (EFT), as the final rule and effective January 2014.

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CMS Plans MSSP Provider Call July 31

Providers curious about the Medicare Shared Savings Program (MSSP) and the Advance Payment Model (APM) are invited to join a national provider call on July 31, from 1:30 to 3 p.m. EDT. The Centers for Medicare & Medicaid Services (CMS) says experts will provide an overview and updates to the MSSP and APM application processes for the Jan. 1, 2013 MSSP start date.

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Coding Tips

AMA Releases Midterm CPT® Code Changes
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UnitedHealthcare Updates Policies for Fourth Quarter
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CMS Updates ECP ICD-9 and ICD-10 Coverage
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Medical News

CMS Reopens NCD for PET Coverage
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States Where Health Care Jobs Are
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ACOs Now Total 154
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More Than 16 Million Seen for Preventive Service in 2012
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Study Concludes Medicare Should Cover CT Colonography
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MPFS Proposed Rule
2013 Payment Rates
Value Modifier
2013 PQRS Changes
EFT Standards Final
MSSP Provider Call
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