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Medicare/Medicaid center issues 2013 rate adjustments

By , - Last modified: November 5, 2012 at 11:01 AM

Primary-care payment rates for Medicare and Medicaid services will get a boost starting in 2013 under the Centers for Medicare and Medicaid Services' newly released payment policies.

As required by the Patient Protection and Affordable Care Act, Medicaid rates for primary care services provided by doctors with specialty designations of family, general internal or pediatric medicine, or a related subspecialty for 2013 and 2014 will increase to match current Medicare rates or the rates specified from the 2009 conversion factor, whichever is greater.

The federal government will cover the difference between the 2009 rates and new ones, at an estimated cost of $5.835 billion in 2013 and $6.055 billion in 2014, with states saving $235 million and $310 million, respectively.

Medicare rates are reapportioned annually in a revenue-neutral system, then increased or decreased by a conversion factor. CMS released the following reapportionment numbers with a note that they don’t include the conversion factor, which, due to the Sustainable Growth Rate, will lead to a 26.5 percent reduction if not averted by Congress.

“While Congress has provided temporary relief from these reductions every year since 2003, a long-term solution is critical,” CMS said.

In the 2013 reapportionment, rates for family doctors will increase 7 percent, with geriatrics and portable X-ray suppliers increasing 5 percent each and internal medicine, nurse practitioners, and physical and occupational therapy increasing 4 percent each.

The largest reductions will be for independent laboratories, down 14 percent; radiation therapy centers, down 9 percent; and diagnostic testing facilities, radiation oncology and neurology, down 7 percent.

CMS noted that the biggest payment increase for primary-care specialties will be from a new payment for managing care in the 30 days after a patient is discharged, and that some of the reductions are primarily due to a misvalued codes initiative.

CMS also issued notice that hospital outpatient rates will increase 1.8 percent in 2013, and ambulatory surgical center rates will increase 0.6 percent.

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