Just Announced: CMS Issues Final Medicare Physician Payment Rule for 2013

This afternoon, the Department for Health and Human Services (HHS) announced it has issued the Medicare Physician Fee Schedule Final Rule for 2013.  According to a news release from HHS, this new rule will ensure doctors are paid the same rates for treating Medicare and Medicaid patients, without raising the costs for states.

The rule comes in response to the Affordable Care Act’s requirement that Medicaid pay physicians practicing in family medicine, general internal medicine, pediatric medicine, and related subspecialists at the same level as Medicare in Calendar Years 2013 and 2014.  The new rate increase will begin in January 2013.

“The health care law will help physicians serve millions of Americans across the country,” HHS Secretary Kathleen Sebelius said.  “By improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones.”

From a fact sheet on the CMS website:

On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to implement a provision of the Affordable Care Act that provides increased payments to certain primary care physicians for specified Medicaid primary care services.

Under this provision, certain physicians who provide eligible primary care services will be paid the Medicare rates in effect in calendar years (CY) 2013 and 2014 instead of their usual state-established Medicaid rates, which may be lower than federally established Medicare rates.

The payment increase applies to primary care services delivered by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine or related subspecialists.

States will receive 100 percent federal financial participation (FFP) for the difference between the Medicaid state plan payment amount as of July 1, 2009, and the applicable Medicare rate.

The rule provides information about how CMS and states will work together to make the increased payments operational.  The rule includes information about the identification of eligible providers and services and how to meet the statutory requirements when making these payments for services provided through managed care.

The rule also provides important information on how this policy applies to the Vaccines for Children (VFC) program, which has its own statutory requirements for billing and payment, and updates the administration fees that may be billed under VFC based on medical inflation rates.

The complete rule can be found by clicking here.

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