Physician Practice

CMS releases 2017 Medicare Physician Fee Schedule proposed rule

Physician Practice Insider, July 12, 2016

CMS released the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule July 7, with policies that look to expand an Innovation Center program, revise payment for care management services, and collect data regarding global period payments.

The agency is proposing to expand the Innovation Center’s Diabetes Prevention Program for all Medicare beneficiaries beginning January 1, 2018. The program includes 16 core sessions provided in a classroom-style setting with training on dietary and behavioral changes for patients. These are followed up with monthly meetings to ensure beneficiaries maintain these changes. CMS is seeking comment on provider enrollment, payment structures, and beneficiary eligibility for the program.

Another goal for the changes in the proposed rule is to improve payment accuracy for primary care, care management, and patient-centered services. CMS is looking to make separate payments for many provider services in these areas, instead of bundling them with evaluation and management (E/M) visit codes that all specialties use.

After CMS’ plan to eliminate global surgery periods in the 2015 MPFS was stopped by Congress in the Medicare Access and CHIP Reauthorization Act of 2015, the agency is looking to begin a data collection project to determine whether such a policy can be put in place. CMS proposes a claims-based strategy for collecting data, as well as surveying 5,000 providers. If the data leads the agency to consider revaluing any services, providers will have a chance to comment in future rulemaking.

In a related proposal, CMS is prioritizing 83 services for review as potentially misvalued due to use with modifier -25 (significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of the procedure or other service). The modifier is used to unbundle services provided during an E/M visit, but CMS believes many of the procedures do not qualify as significant, separately identifiable services.

For more information, see CMS' fact sheet. Comments are due by September 6 and a final rule is expected by November 1.

This article originally appeared on Medicare Compliance Watch.

Most Popular