The estimated 7% increase to primary care payments included in the proposed 2013 Medicare physician fee schedule is based mostly on a new G-code for post-discharge transitional care management. Additional work is required to use the code, but you would also get extra money for services physicians already provide.

Cardiologists, ophthalmologists and group practices face sharp pay cuts for reading imaging tests as CMS pushes further expansion of the multiple procedure payment reduction (MPPR) initiative in its 2013 proposed physician fee schedule. CMS proposes to reduce rates for the technical component (TC) of diagnostic services – previously untouched by the MPPR.

Practices with two to 24 providers would have the option of an easier way to report Physician Quality Reporting System (PQRS) measures next year through the group practice reporting option (GPRO). In its 2013 proposed physician fee schedule, CMS would expand the definition of group practice, previously characterized as a practice with 25 or more providers, to increase participation.

Online exclusive: You’ll have a tougher time getting paid for preventive services, such as alcohol screening, now that CMS has bundled several screening services with office visits in its National Correct Coding Initiative (CCI) edits that were effective July 1.

If your practice participates in the EHR incentive program, you might be able to get an exemption from e-prescribing (e-Rx) penalties.CMS proposes two new significant hardship exemption categories for 2013 and 2014.

Based on their performance in 2013, practices with 25 or more providers would be subject to a 1% payment penalty or an unspecified bonus in 2015 from CMS’ value-based payment modifier, an Affordable Care Act reform that would apply to all practices in 2017.

The payment modifier, aligned closely to the Physician Quality Reporting System (PQRS), has been called a potential “game-changer” by the Medical Group Management Association because it will pay practices based on the quality of care compared with cost.

The proposed 2013 Medicare physician fee schedule is a departure from recent rules in that it contains a plethora of policy information.

“If I had looked at a proposed [fee schedule] eight years ago, there would have been more issues about coding, and this rule is really about policy and where Medicare wants to move in the future,” says Betsy Nicoletti, CPC, consultant with Medical Practice Consulting in Springfield, Vt.

Track your payment changes for imaging services and office visits from 2009 through 2012 and your prospective payments for next year based on the proposed 2013 Medicare physician fee schedule. Note: Reimbursement rates for 2013 services were calculated using the 2012 conversion factor and do not reflect the rates for the actual conversion factor to be finalized by Congress for 2013.

How do you code encounters for patients with a severe upper respiratory infection and impacted cerumen who were prescribed an antibiotic injection and had the earwax removed?