Measure specifications, reporting options and changes for 2013
Beginning April 1, 2013, Medicare Part B physician claims submitted for reimbursement will be reduced by 2 percent as part of across-the-board cuts in federal agency spending caused by the sequestration process. Costs for drugs administered by the physician that are included in those claims are also subject to the 2 percent cut.
Beneficiary copayments and deductibles do not change as a result of sequestration. The cut is imposed only on the 80 percent portion of the allowed charge for a service that a participating physician receives directly from Medicare. For example, if the Medicare allowed charge is $100 for a service before sequestration, Medicare would technically allow $98 for the same service after sequestration. Therefore, the physician would be paid $78.40 by Medicare (98 percent of $80) and $20 by the beneficiary (20 percent of $100).
The sequestration cut also applies to incentive payments that physicians receive for their participation in the Medicare Electronic Health Record Incentive Program and to ambulatory surgery center reimbursement.
For unassigned claims for services provided by physicians who do not participate in the Medicare program, the 2 percent cut will be applied to the Medicare payment made to the beneficiary. The physician’s patient billing does not change.
Sequestration cuts are scheduled to last for nine years, through 2021.
|How is the 2% payment reduction identified on the remittance advice (RA)?||Claim adjustment reason code CARC 223 Adjustment code for mandated Federal, State, or local law/regulation that is not already covered by another code and is mandated before a new code can be created, is used to report the sequestration reduction.|
|Is the reduction based on the date of service or date of receipt?||Date of service.|
|How are unassigned (non-par) claims affected?||Medicare's payment to beneficiaries for unassigned claims is subject to the 2% reduction. The non-participating physician will continue to collect his/her full limiting charge from the patient.
CMS encourages physicians to discuss the impact of the sequestration reductions with their patients.
Over the past three decades, there have been many changes in how medical care is paid for and where it is delivered. Those of us who have lived through the various iterations can be forgiven for our skepticism about any new “system” purported to revolutionize the delivery of health care. However, the newest acronym — ACO — stands for a concept that could represent a sea change in the very complex system of medical care that we have in our country.
During this free 60 minute webcast [AAOE login required] presented by BSM Senior Consultant, Derek Preece, you’ll learn about what an accountable care organization is, why they were authorized by Congress in 2010, and what their effect may be on your practice.
The recorded presentation will include: