On November 2, 2016, the Centers for Medicare and Medicaid Services (CMS) released the final Medicare Physician Fee Schedule (MPFS) for 2017. The Final Rule updates payment policies and payment rates for services furnished by physicians and other practitioners in all sites of service under the MPFS. These services include but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. These policy changes and payment rates are effective as of January 1, 2017.
Some key payment and policy changes summaries are presented below:
Physician payment rates will increase in 2017: The CY 2017 MPFS conversion factor increased from $35.80 in 2016 to $35.89 in 2017. The CY 2017 MPFS conversion factor reflects a budget neutrality adjustment of -0.013%. The increase in fees will vary by codes. Do you want to know how your accounts’ billing codes will be impacted? Click here .
CMS focuses on improving the value of primary care services For 2017, CMS places will increase reimbursement for certain codes and make separate payments for new codes for primary care services. CMS is also finalizing a number of coding and payment changes to better identify and pay for primary care, care management, and cognitive services. Among the changes are new codes to pay primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions. In addition, CMS finalized several proposals related to chronic care management.
CY 2017 Identification and Review of Potentially Misvalued Services.
Congress passed several bills, including provisions in the Affordable Care Act, directing CMS to identify “misvalued” services and re-evaluate them for appropriate adjustments to their relative values. Potentially misvalued services in the following categories are being considered:
- Codes that have experienced the fastest growth;
- Codes that describe new technologies or services within an appropriate time period (such as 3 years) after the relative values are initially established for such codes;
- Codes which are multiple codes that are frequently billed in conjunction with furnishing a single service;
- Codes with low relative values, particularly those that are often billed multiple times for a single treatment;
- Codes that have not been subject to review since implementation of the fee schedule.
- Codes that account for the majority of spending under the physician fee schedule.
- Codes for services that have experienced a substantial change in the hospital length of stay.
Contact us to track if and how your account billing codes are impacted. Contact Us.
CMS is also finalizing values for the new CPT moderate sedation codes. In addition, CMS is adopting a uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure. CMS is also augmenting the new moderate sedation CPT codes with an endoscopy-specific moderate sedation code, and finalizing valuations reflecting the differences in physician survey data between gastroenterology and other specialties.
CMS finalized its proposal to expand eligible telehealth services. CMS is finalizing and adding several codes to the list of services eligible to be furnished through telehealth. The additional codes include those for end-stage renal disease-related dialysis, advanced care planning and critical care consultations. The critical care consultations provided via telehealth will use the new Medicare G-codes.
CMS is implementing the new coding for Mammography Services. CMS is finalizing a new coding framework based on new CPT coding for mammography services.
If you are interested in a more extensive summary of the Physician Final Rule and its potential impacts on your product, Contact Us.
The PFS Final Rule is expected to be published in the Federal Register on November 15.
Sources
https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26668.pdf
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-11-02.html