Medicare Rates for 2013: Implications for Practices

Updated Jan. 15, 2013

Following action by Congress on Dec. 31 and Jan. 1, all services for Medicare patients provided after Jan. 1, 2013 will be reimbursed at 2012 rates.

However, the CMS fee schedule – as of today – still reflects the planned 27% cut, and CMS has not yet updated the schedule. By law, Medicare is required to pay physicians the lesser of the submitted charge or the Medicare approved amount, so the AMA is advising physicians not to submit claims until CMS revises the fee schedule to reflect the 2012 rates. These revisions are expected shortly.

[Update: The CMS contractor for New England has told us that the 2013 fee schedule has been updated, and reflects 2012 rates. The advice in the paragraph above is no longer valid.]

Also, because of the uncertainty over payment rates, CMS has given physicians until Feb. 15 to decide whether they want to change their Medicare participation status for the 2013 calendar year. If you choose to change your participation status, the effective date would be retroactive to Jan. 1, 2013.

Review the issues unique to Massachusetts physicians, and download instruction on how to change your status.

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