At the end of October 2014, the Centers for Medicare & Medicaid Services (CMS) released the 2015 Medicare Physician Fee Schedule (PFS), which updates payment policies and payment rates for services provided to Medicare beneficiaries by physicians and other practitioners. The main provision of this final rule is that physician payment rates will be reduced by 21.2 percent after March 2015. So, when the Protecting Access to Medicare Act of 2014 signed by the President (which prohibited a reduction in the PFS rates from January through March 2015) expires, physicians will see a large reduction in their Medicare payment. There are several other provisions which can also have a significant impact on their entire billing process.
The other provisions under the 2015 Medicare Physician Fee Schedule are as follows.
- Medicare predominantly pays physicians as well as other practitioners for care management services provided as a part of face-to-face visits. But from 2015, CMS will pay for chronic care management (CCM) services separately for Medicare beneficiaries with two or more significant chronic conditions. The rule fixes a payment rate for CCM services that may be billed up to once every month for each qualified patient. CCM services include medication management, communication and coordination among a care team and consistent review of a patient’s plan of care.
- With this new rule, CMS introduces a new process for determining fee schedule payment rates that will allow transparency in setting PFS rates. The rule allows checking payment rates and commenting rulemaking before it is being adopted.
- CMS is extending the telehealth benefit available to Medicare beneficiaries with the new rule by including the services, annual wellness visits, psychotherapy, psychoanalysis and prolonged evaluation and management services.
- The final rule introduces new requirements related to the 2017 Physician Quality Reporting System (PQRS) payment adjustment. PQRS is a pay-for-reporting program that supports reporting of quality information by providing incentive payments and payment cuts to eligible professionals. From 2015, the program will apply a payment adjustment or cut to professionals if they won’t report data on quality measures for particular professional services.
The final rule reflects a broader strategy to provide high quality care at lower cost. Physicians are required to improve their documentation, train their coders and better manage their revenue cycle in line with the new provisions in the rule. If they are struggling to manage the number of increasing patients as result of the Affordable Care Act (ACA) and running out of time, they can consider obtaining support from a professional billing and coding company. CMS seeks to find better ways to pay physicians and other practitioners and ensure better provision of care to generate better health outcomes and enhanced collaboration across the healthcare system.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.