On Oct. 31, CMS issued the final rule that updates the payment policies and payment rates for the Medicare Physician Fee Schedule for 2015. The final rule was published in the Federal Register Nov. 13.
Payments for managing patients on home dialysis
CMS said it modified its criteria for furnishing outpatient per diem ESRD-related services in partial month scenarios. The agency said it would allow the monthly capitation payment (MCP) practitioner to bill for the home dialysis MCP service for the home dialysis (less than a full month) scenario if the MCP practitioner furnishes a complete monthly assessment of the ESRD beneficiary and at least one face-to-face patient visit during the month.
In the CY 2011 PFS final rule CMS changed its policy for the home dialysis MCP service to require the MCP practitioner to furnish at least one face-to-face patient visit per month as a condition of payment. However, CMS said it inadvertently did not modify its billing guidelines for home dialysis (less than a full month) to be consistent with partial month scenarios for center-based dialysis patients.
According to CMS, several stakeholders strongly supported its proposed change for practitioners managing patients on home dialysis.
The rule also changes several of the quality reporting initiatives associated with Physician Quality Reporting System (PQRS).
Major highlights include:
- Eligible Professionals and group practices that meet the criteria for 2015 PQRS reporting will avoid the negative payment adjustment in 2017
- A total of 255 measures in 2015, including:
- 63 outcome-based measures
- 19 cross-cutting measures
- Addition of two measures groups
- Removal of five measures groups
- Critical Access Hospitals Method II (CAH-II) may now report PQRS via claims
There is no incentive for 2015 PQRS reporting.