Physician Practice

CMS releases revisions to payment policies and other changes as part of the Medicare Physician Fee Schedule (MPFS) CY 2016 final rule

Physician Practice Insider, November 3, 2015

On October 30, CMS released its 2016 MPFS final rule with comment period addressing changes to the physician fee schedule and other Medicare Part B payment policies to ensure that the payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute.

In the rule, CMS finalized several new policies related to recent legislation as well as changes to quality initiatives (e.g., the Physician Quality Reporting System [PQRS], Physician Compare, the Physician Value-Based Payment Modifier, and the Medicare Shared Savings Program).

The rule also finalized the proposed provision to pay providers for advance care planning services to seniors and other beneficiaries.

According to the fact sheet:
Consistent with recommendations from the American Medical Association (AMA) and a wide array of stakeholders, CMS is establishing separate payment and a payment rate for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners…  Establishing separate payment for advance care planning codes to recognize additional practitioner time to conduct these conversations provides beneficiaries and practitioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families. CMS is also finalizing payment for advance care planning when it is included as an optional element of the “Annual Wellness Visit.

In this first MPFS final rule since the repeal of the SGR formula by the Medicare Access and CHIP Reauthorization Act of 2015, CMS is beginning implementation of the new payment system, the Merit-Based Incentive Payment System.

"CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers," CMS Acting Administrator Andy Slavitt said in a press release. “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.”

The final rule also updated many payment provisions, including making changes to the following:
•    Part B drugs/payment for biosimilar biological products
•    Implementation of the statutory phase-in of significant RVU reductions
•    Incident-to policy
•    Physician self-referrals
•    Medicare physician and practitioner opt-outs
•    Use criteria for advanced diagnostic imaging services

“The calendar year 2016 PFS final rule is one of several final rules reflecting a broader administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people,” according to the fact sheet.

For more information, view the Medicare Physician Fee Schedule final rule and its accompanying fact sheet. The 2016 PQRS payment adjustment fact sheet is also available on the CMS website.

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