NGS Medicare Announces Important Updates Effective January 1, 2013

NGS Medicare has released several updates regarding changes that took effect on January 1, 2013. The principle highlights include the following:
  • The new fee schedule will be effective as of January 1, 2013, but is not published on the NGS web site at this time. For bookkeeping purposes, you may want to consider holding 2013 Medicare billings until later in the month. Check the website for updates.
  • Participation in PQRS is no longer optional as of January 1, 2013. Providers who do not report quality measures beginning January 1, 2013 will see a 1.5% fee reduction penalty starting in 2015.
  • EHR incentives are also still in effect with financial incentives available to those who qualify.
For more details on this release, please see the article below. Additionally, the New York Chiropractic College will be offering a NY Medicare educational program on January 10, 2013 at all locations. Among the topics to be covered are the Physician Quality Reporting System (PQRS), along with other Medicare procedures.

As always, the NYSCA will continue to send updates as we receive them.


President Obama Signs the American Taxpayer Relief Act of 2012
--New Law Includes Physician Update Fix through December 2013--

On Wednesday, January 2, 2013, President Obama signed into law the American Taxpayer Relief Act of 2012. This new law prevents a scheduled payment cut for physicians and other practitioners who treat Medicare patients from taking effect on January 1, 2013. The new law provides for a zero percent update for such services through December 31, 2013. This provision guarantees seniors have continued access to their doctors by fixing the Sustainable Growth Rate (SGR) through the end of 2013...

Section 601 – Medicare Physician Payment Update – As indicated above, the new law provides for a zero percent update for claims with dates of service on or after January 1, 2013, through December 31, 2013. The Centers for Medicare & Medicaid Services (CMS) is currently revising the 2013 Medicare Physician Fee Schedule (MPFS) to reflect the new law’s requirements as well as technical corrections identified since publication of the final rule in November. For your information, the 2013 conversion factor is $34.0230.

In order to allow sufficient time to develop, test, and implement the revised MPFS, Medicare claims administration contractors may hold MPFS claims with January 2013 dates of service for up to 10 business days (i.e., through January 15, 2013). We expect these claims to be released into processing no later than January 16, 2013. The claim hold should have minimal impact on physician/practitioner cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt. Claims with dates of service prior to January 1, 2013, are unaffected. Medicare claims administration contractors will be posting the MPFS payment rates on their websites no later than January 23, 2013.

The 2013 Annual Participation Enrollment Program allowed eligible physicians, practitioners, and suppliers an opportunity to change their participation status by December 31, 2012. Given the new legislation, CMS is extending the 2013 annual participation enrollment period through February 15, 2013. Therefore, participation elections and withdrawals must be post-marked on and before February 15, 2013. The effective date for any participation status changes elected by providers during the extension remains January 1, 2013. (continued at


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