The proposed 2013 Medicare physician fee schedule's significant payment boost to primary care would hinge on the addition of a new G-code that allows community physicians to bill for post-discharge care separately and in addition to traditional E/M codes.
The 7% increase to primary care physician payments that CMS boasted in its press release would come primarily from the estimated impact of this code’s addition. So here’s a look at what services would qualify for post-discharge transitional care management (work RVU=1.28):
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Assuming responsibility for patient care without a gap –
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Obtaining and reviewing discharge summary;
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Reviewing diagnostic tests and treatments;
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Updating the patient’s medical record.
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Establishing or adjusting a plan of care;
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Communication with the beneficiary and/or caregiver (direct contact, telephone, electronic);
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Communication with other healthcare professionals who will (re)assume care;
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Service would only be billable at 30 days post discharge or later and would complement the E/M codes;
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Must include medical decision-making of moderate or high complexity during the service period;
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The physician or qualified non-physician practitioners billing the new G-code would be required to have a face-to-face visit with the patient in either the 30 days prior to the transition of care or within 14 days following the transition of care.
Check out p. 680-681 of the rule via the link above to see a breakdown of the estimated payment impact the new code would have on each specialty.
E-Rx exemptions
If your practice participates in the electronic health records (EHR) incentive program, you might be able to get an exemption from e-Prescribing (e-Rx) penalties.
CMS proposed two new hardship exemptions in its 2013 proposed physician fee schedule because the EHR meaningful use program requires “a certain level of electronic prescribing activity,” CMS states in the rule released July 6.
CMS’ proposals for the new “significant hardship exemption categories for the 2013 and 2014 e-Rx payment adjustments” are:
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Eligible professionals or group practices who achieve meaningful use during certain e-Rx payment adjustment reporting periods.
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Eligible professionals or group practices who demonstrate intent to participate in the EHR incentive program and adoption of Certified EHR Technology.
Check out p. 531-543 of the rule to read the details.
Look for more information on the proposed physician fee schedule in an upcoming issue of Part B News.