The Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule Final Rule Nov. 1, 2012, which addresses changes to the physician fee schedule as well as other important Medicare part B payment policies. The rule is effective Jan. 1, 2013 and is published in the Nov. 25, 2012 Federal Register.

We finished 2012 with a Medicare Conversion factor (the Medicare payment per RVU) of $34.0376. The much loathed SGR (Sustainable Growth Rate) formula remains on the books and with the expiration of the latest congressional “patch” on Dec. 31, 2012 the 2013 Final Rule published a conversion factor of $25.0008 representing a 26.5% cut to physician payments. Each year, after significant and organized physician pleading Congress has staved off our draconian cuts since 2003 with a variety of short term patches.

According to the CMS, specialty specific impact analysis Emergency Medicine will not see a significant decrease in our overall RVU values. As published in the 2013 rule Emergency Medicine will experience a 0% update to our overall RVU values in 2013. Essentially, our RVUs are stable and relatively unchanged. This is independent of any change to the conversion factor. The RVUs for our major reimbursement drivers, the E/M codes have only second decimal point adjustments predominantly due to small changes in Practice Expense. Of note, the work RVUs have not changed for 2013 and remain stable at 2012 levels.

Other services frequently provided by Emergency Physicians have also had their RVUs adjusted by the 2013 rule. For 2013, Critical care is essentially unchanged and Observation will see small increases.

On Nov. 1, 2012, CMS released the final regulations which implement Section 1202 of the Affordable Care Act. This section increases Medicaid payments for specified primary care services to Medicare levels for certain primary care physicians for the years 2013 and 2014. CMS has stated that it did not intend to allow anyone Board Certified in Emergency Medicine, to participate in the program.

The extended online version of this article provides extensive tables and discussion of EP-related RVU and CPT coding changes in 2013.