The Centers for Medicare and Medicaid Services (CMS) on Nov. 1 released the final 2013 Medicare Physician Fee Schedule, which sets payment rates and related policies for next year. The rule includes many important decisions relevant to cardiovascular medicine. CMS estimates that the rule has an overall -2 percent impact on cardiovascular medicine. This would be in addition to the 26.5 percent cut that is the result of the Sustainable Growth Rate (SGR) formula and the 2 percent cut associated with the sequestration provisions of the Budget Control Act of 2011.

"This year's final rule cuts payments for important cardiovascular services at a time when many cardiology practices are already vulnerable," said ACC President William Zoghbi, MD, FACC. "Further cuts in reimbursement targeted at physicians only will make health care delivery unsustainable. Furthermore, the ongoing uncertainties about Medicare payments that are a direct result of the SGR formula make it nearly impossible to plan and invest in the future. We hope that CMS and Congress will work together to make sure that quality care can be provided at the right price without unintended consequences."

The rule specifies the following for payment of cardiovascular services:

New Codes and Payment Levels for PCI and Ablation-EP Studies

As part of ongoing efforts to evaluate potentially misvalued services, new CPT codes have been created to report PCI as well as to bundle EP studies with ablation. The physician work RVUs CMS finalized result in physician work RVU reductions of roughly 20 percent to the family of PCI codes and roughly 27 percent to the family of EP/ablation codes. The impact will vary depending on practice patterns. The ACC is disappointed CMS did not adopt the RVU values developed through the RUC process. Instead, CMS reduced payment for new ablation add-on codes and bundled PCI add-on codes into the base procedures. The College will take appropriate action to attempt to rectify these flawed decisions. Don't forget to order the 2013 CPT Reference Guide for Cardiovascular Coding.

Multiple Procedure Payment Reduction

CMS finalized its proposal to expand a multiple procedure payment reduction to cardiovascular services, so that if more than one cardiovascular service is provided on the same day to the same patient, the technical component of the less expensive service is reduced by 25 percent. This reduction does not apply to office visits but applies to most cardiovascular diagnostic and therapeutic services. It also does not apply to services billed under the hospital outpatient prospective payment system. CMS finalized this rule despite strong objection from ACC, other stakeholders and 60 members of Congress who sent a letter criticizing the proposed cut. 

PQRS and E-Prescribing

CMS finalized provisions related to the Physician Quality Reporting System (PQRS). Physicians that successfully participate in PQRS in 2013 will receive a 0.5 percent bonus. They will also avoid a 1.5 percent penalty in 2015. Similarly for e-prescribing, successful participants will receive a 0.5 percent bonus for participation in 2013 and avoid a 1.5 percent reduction in 2014. New hardship exemptions for the Electronic Health Record Incentive Program allow participants to avoid the payment adjustment for e-prescribing. For both programs, there are slightly different provisions for avoiding the penalty and getting the bonus. 

Value-Based Modifier

CMS finalized its proposal to begin to adjust payment for quality and cost of care starting with groups of 100 or more professionals in 2015. Because of data collection requirements, this payment adjustment will be based on performance in 2013. Physicians in large groups will have an option to participate in the payment adjustment but must participate in PQRS as a group to avoid being penalized as a low quality provider. Your ACC will be offering a webinar on the value-based purchasing initiative in December that will be particularly useful for large groups but also useful for smaller groups to whom this policy will soon apply.

For additional details on top codes for 2013, click here.

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