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presentation

Proposed 2017 Rules of CMS for Medicare Physician Fee Schedule

April 25, 2017



Proposed 2017 Rules of CMS for Medicare Physician Fee Schedule

Every year this time, medical practitioners of America get the glimpse of what their Medicare payment will look like in the coming year. With new administration on board, there are lot of speculations of health care industry going under few changes.

CMS - Centers for Medicare & Medicaid Services issued a final rule updating payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule -PFS, which was revealed on January 1, 2017.

In the rule, CMS finalized a number of PFS policies which will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioural health issues, and cognitive impairment conditions.

CMS proposed to transform how Medicare pays for primary care through the new focus on care management and behavioural health which is specifically designed to recognize the importance of the primary care work physicians perform

  • The rule also proposes policies to expand the Diabetes Prevention Program within Medicare starting January 1, 2018.

The annual PFS updates payment policies, payment rates, and quality provisions for services provided in calendar year 2017.

  • These services include, but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. In addition to physicians, the fee schedule pays a variety of practitioners and entities, including nurse practitioners, physician assistants, physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities.

Additional policies proposed in the 2017 payment rule include:

  • Primary care and care coordination
  • Mental and behavioural health
  • Cognitive impairment care assessment and planning
  • Care for patients with mobility-related impairments

Several of the proposed policy changes would improve the quality of care Medicare patients receive by better supporting their physicians and other healthcare providers.

These proposals are based on feedback from stakeholders, including beneficiary and patient advocates, as well as healthcare providers, including hospitals, ambulatory surgical centers and the physician community.

Proposed changes include:

  • Addressing physicians' concerns regarding pain management
  • Focusing payments on patients rather than setting
  • Improving patient care through technology
  • Emphasizing health outcomes that matter to the patient

The key factor of the proposed rule is to help physicians prepare for their betterment of practice. Some of the major provisions to take notice are:

  • As previously reported, CMS has proposed values for new moderate sedation codes, removing the associated value from the majority of endoscopic procedures.
  • For those who provide their own moderate sedation, there will be no impact on physician work.
  • Those who use anaesthesia professionals will see a reduction in physician work relative value units and office practice expense for the majority of GI endoscopy procedures.
  • CMS proposes to maintain the value of anaesthesia services furnished in conjunction with upper CPT 00740 and lower CPT 00810 endoscopy services for 2017.
  • However, given the significant change in the relative frequency with which anaesthesia codes are reported with colonoscopy services more than 50 % of the time for several types of colonoscopy procedures, CMS believes the relative values of these anaesthesia services should be re-examined.
  • Claims reporting of post-operative visits will be required only for high volume/high cost procedures instead of all global services. High volume/high cost procedures will be defined as services that are furnished by more than 100 practitioners and are either furnished more than 10,000 times or have allowed charges of more than $10 million annually.
  • CPT code 99024 will be used to report post-operative visits instead of the proposed global surgery codes -G-codes, which would have required reporting 10 minute time increments and levels of intensity.
  • Reporting will only be required for a sample of practitioners in practices of 10 or more in specified states instead of all practitioners as proposed.
  • Practitioners who are required to report would need to do so for services furnished on or after July 1, 2017, instead of Jan. 1, 2017.
  • Teaching physicians will be subject to the reporting requirements in the same way as other physicians and should use the GC or GE modifier as appropriate to indicate the involvement of residents.

CMS proposed rules for Medicare Physicians to improve payment accuracy for primary care, care management, and cognitive services. It expects to reduce administrative burden associated with chronic care management codes to improve health care delivery.

 

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