CMS Proposes 2013 Fee Schedule Rule; Changes to PQRS

2013 Medicare Physician Fee Schedule Proposal

On July 30, 2012, the Centers for Medicare and Medicaid Services (CMS) proposed its 2013 Medicare Physician Fee Schedule rule. A National Provider Call regarding updates to quality initiatives proposed in this rule was held earlier this week. Slides from that call can be found here.

The proposed rule includes a projected 27 percent cut to physician payments effective January 1, 2013 due to the flawed Sustainable Growth Rate (SGR) Formula. Additionally, the fee schedule rules propose a number of changes to several Medicare programs in which North Carolina physicians may participate.

Physician Quality Reporting System (PQRS) Changes

In 2013, CMS proposes the addition of four new measure groups bringing the total to 26 measure groups and 264 individual PQRS measures. CMS also plans to include these measures with the EHR Incentive Program and the Medicare Shared Savings Program.

Successful participation in PQRS for 2013 or 2014 will result in a .5 percent incentive payment for allowed charges for all covered services during the reporting period. Health care professionals that qualify for incentives in 2013 and 2014 will avoid penalties in 2015 and 2016.

In order to initiate PQRS participation, CMS is proposing the following changes to the reporting model:

  • The minimum number of patients that health care professionals are required to report via the claims and registry reporting option will decrease from 30 to 20.
  • The definition of group practice will be expanded to also include groups with 2-24 eligible health care professionals, rather than the current definition of 25 or more.
  • The use of the claims registry and EHR-based reporting mechanisms to group practices of 2-99 EPS, in addition to groups of 25 or more eligible professionals, will be expanded.

CMS will solicit comments on the proposed rule until 5 pm, EST on Tuesday, September 4, 2012.


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