CMS estimates that payments to neurologists will decrease by seven percent (-2% work RVU+-5% practice expense RVU). According to CMS, the reduction is a result of the potentially misvalued code initiative, which impacted EMG and nerve conduction tests. On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and rates for physician services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year (CY) 2013. Without a change in the law from Congress, the seven percent decrease does not include the effects of the 26.5 percent reduction in Medicare payments from the Sustainable Growth Rate (SGR) in CY 2013.
This article will provide an overview of the items in the MPFS final rule of interest to neurology.
Transitional Care Management (TCM)
Neurologists will be able to report codes and to receive reimbursement for the non-face-to-face work associated with transitioning a patient from institutional to community-based care. As part of ongoing efforts to support care coordination, CMS finalized its proposal to reimburse physicians for the non-face-to-face services related to the TCM furnished to Medicare beneficiaries following discharge from a hospital or nursing to the beneficiary's primary physician in the community. CMS clarified that while they expect the TCM codes to be billed most frequently by primary care physicians, cognitive specialists who furnish the requisite services in the code descriptions may also bill the new TCM codes.
Nerve Conduction Tests
Neurologists performing electrodiagnostic testing will have a new coding structure to use. Seven new nerve conduction codes (CPT® codes 95907 through 95913) were created that bundle the work of multiple nerve conduction studies into each individual code. In the new coding structure, the unit of service in codes 95907–95913 is the number of nerve conduction studies performed; whereas the unit of service in previous codes 95900–95904 was each nerve. The AAN is disappointed that CMS did not adopt the physician work RVU values developed through the RUC process and will take appropriate action to attempt to rectify the interim values.
PQRS and E-prescribing
The final rule continues to align quality reporting across programs to reduce burden and complexity. CMS finalized provisions related to the Physician Quality Reporting System (PQRS). Physicians that successfully participate in PQRS in 2013 will receive a 0.5 percent bonus and will avoid a 1.5 percent penalty in 2015. Successful participants for e-prescribing will receive a 0.5 percent bonus for participation in 2013 and avoid a 1.5 percent reduction in 2014. New hardship exemptions for the e-prescribing Incentive Program allow participants to avoid the payment adjustment if also participating in the Electronic Health Records Incentive Program.
Value-Based Payment Modifier
The value-based payment modifier provides differential Medicare payments to physicians based on comparison of the quality of care furnished to beneficiaries and the cost of care. The statute allows CMS to phase in the value modifier over three years from 2015-2017. For 2015, the final rule applies the value modifier to groups of physicians with 100 or more eligible professionals, a change from the proposed rule, which would have set the group size at 25 or above.
The AAN will review the final rule and submit any comments needed to protect the interests of neurologists by the December 31, 2012, deadline.
REGISTER NOW: The AAN is hosting a FREE webinar on December 4, 2012 to discuss the new nerve conduction codes, effective January 1, 2013.
SAVE THE DATE: The AAN is hosting a FREE webinar in January on the 2013 final MPFS rule. Registration for the webinar opens in early December, 2012.