2013 proposed fee schedule: Orthopedists’ fees could drop 1% with SGR fix

Why This Topic Matters

Practices that bill Medicare need to understand proposed fee schedule changes because they can affect payment, documentation, and reporting workflows across multiple specialties. The article also places these changes in the context of SGR-related payment uncertainty and future quality-based payment adjustments.

Article Sections

1. Payment shift and orthopedic impact

   Summarizes the proposed Medicare physician fee schedule changes and their general effect on specialty and primary care payments. It also introduces the orthopedic impact discussed in the article.

2. New requirements for reporting therapy

   Describes proposed therapy outcomes reporting requirements for Medicare claims and the planned implementation timeline. The section focuses on the new reporting framework and related claims-processing changes.

3. New face-to-face encounter requirements for durable medical equipment (DME)

   Outlines proposed documentation and encounter requirements tied to DME orders and supplier communication. It also notes the related proposed payment and visit-reporting framework.

4. Expansion of the MPPR on imaging and other diagnostic services

   Covers proposed changes to multiple procedure payment reduction policy for diagnostic imaging interpretations. The discussion highlights how the policy would affect group practice billing for same-day services.

5. Value-based payment modifier would reward or penalize large practices in 2015

   Explains the proposed value-based payment modifier and its connection to PQRS performance and future payment adjustments. The section addresses how the policy would apply to larger practices and reporting participation.

6. Comment period, final rule timing, and SGR context

   Provides the rule’s comment deadline, expected final publication timing, and implementation date. It also places the proposal in the context of congressional action on the SGR formula.