How Will the 2013 Payment Rates Affect Your Practice?

November 15, 2012

AGA has analyzed the 2013 Medicare physician fee schedule final rule to determine its impact on gastroenterology. The final rule reduces reimbursement rates for physician services in 2013 by 26.5 percent — a drastic cut that AGA is committed to fighting.

AGA, along with all of organized medicine, will continue to advocate for a permanent solution to the broken payment system that provides fair, equitable and predictable reimbursement to physicians. To help you better understand the impact of these cuts to your practice, we have prepared a payment analysis for GI codes paid under the physician fee schedule, which details payment rates with the 26.5 percent reduction. In addition, we have included an analysis of what payments would be if Congress mandates a short-term fix with a payment freeze.
By law, CMS is required to make these reductions, which can only be averted by an act of Congress. AGA understands and appreciates concerns about government spending, but believes steps must be taken to protect and strengthen the Medicare program. We support CMS in its call to Congress to fix the current sustainable growth rate (SGR) formula. Before access to care is further threatened for the millions of patients who depend on the Medicare program, Congress must replace the SGR formula with a stable and equitable payment mechanism that reflects the costs of caring for Medicare beneficiaries and ensures access to high-quality care.
CMS also released the final rule for payments to ambulatory surgery centers (ASCs) and hospital outpatient departments, which includes increases in payment rates for 2013. Payments to ASCs will increase by 0.6 percent and payment rates under the outpatient protective payment system will increase by 1.8 percent, effective Jan. 1, 2013. AGA has prepared payment analyses for GI codes paid under the ASC and hospital outpatient payment systems.
The final rules appear in the Nov. 15, 2012, Federal Register.

How can you help?

Learn more about the issues: Join Carla H. Ginsburg, MD, MPH, AGAF, chair, AGA Public Affairs & Advocacy Committee, tonight at 8 p.m. ET, for a webinar during which you will hear the latest on hits projected for practice reimbursement, the effect of sequestration on the practice of medicine and quality reporting milestones. Register now.

Contact your lawmaker: Mark your calendar for Tuesday, Dec. 4 to be a part of the first ever AGA Virtual Advocacy Campaign. Join GIs from across the country and flood Congress with phone calls during the lame-duck session. We must tell lawmakers to protect medicine and our patients, and avert a serious fiscal crisis. You will receive more information on this important day as it draws closer.

Continue to read AGA eDigest and the AGA Washington Insider for more information on what GIs need to know about the final rule.

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