On July 3, the Centers for Medicare & Medicaid Services issued a proposed rule that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS), starting Jan. 1, 2015.
Medicare primarily pays physicians and other practitioners for care management services as part of face-to-face visits. Last year, CMS finalized a separate payment, outside of a face-to-face visit, for managing the care of Medicare patients with two or more chronic conditions beginning in 2015. CMS is proposing details relating to the implementation of the new policy, including payment rates.
In addition, CMS is proposing a new process for establishing PFS payment rates that the agency said would be more transparent and allow for greater public input prior to payment rates being set. Under the new process, payment changes would go through notice and comment rulemaking before being adopted, beginning for 2016.
The proposed rule also proposes changes to several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System (PQRS), Medicare Shared Savings Program, and Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare tool on the Medicare.gov website. The rule would also continue the phased-in implementation of the physician value-based payment modifier (Value Modifier), created by the Affordable Care Act, that would affect payments to physicians and physician groups, as well as other eligible professionals, based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare fee-for-service program.