Health Center Regulatory Issues

2013 Medicare Upper Payment Limits Announced

By: Susan Sumrell

CMS has released the 2013 Medicare Upper Payment Limits (also known as the “Medicare cap”). For rural centers, the limit will be $110.78 and for urban centers the limit will be $128. This represents a 0.8% increase in the Medicare Economic Index (MEI) over the 2012 limits. This limit is effective January 1, 2013 through December 31, 2013.

While we are talking Medicare, just a reminder that the Affordable Care Act (ACA) created a new reimbursement methodology for FQHCs, effective October 2014. CMS is currently in the process of developing this new methodology and is collecting data from health centers to assist with this development. As required by the ACA, all health centers are required to submit the HCPCS codes of the services that they are providing to their Medicare patients.  Please take a minute to make sure your center is submitting the proper codes to Medicare on each and every one of your Medicare claims and let us know if you are experiencing any issues with this process.  This data is critical to ensure an appropriate Medicare payment under the new system.