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CMS Releases Medicare Physician Fee Schedule Final Rule

Strategic Management Services, LLC | December 2014
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The Centers for Medicare & Medicaid Services (CMS) recently released a final rule with comment period revising payment policies under the Medicare Physician Fee Schedule (PFS) and implementing other policy changes related to Medicare Part B payments for calendar year (CY) 2015.  The final rule also revises various quality reporting initiatives.

Key highlights of the final rule include:

  • Information relating to separate payments for managing the care of Medicare patients with two or more chronic conditions.
  • Adoption of a new process, beginning in CY 2017, allowing for increased public input of PFS payment rates.
  • Addition and removal of measures, bringing the Physician Quality Reporting System individual measure set to 225 measures.
  • Changes to hardship exceptions for the Medicare Electronic Health Record Incentive Program.
  • Additional coverage of telehealth services.
  • Requirements for hospitals and physicians reporting services delivered in off-campus provider-based departments.
  • Finalization of four changes to the Open Payments Program.

CMS is accepting comments until December 30, 2014.  Most provisions of the final rule are effective on January 1, 2015.

The PFS final rule is available at:

http://www.gpo.gov/fdsys/pkg/FR-2014-11-13/pdf/2014-26183.pdf.

The CMS fact sheet on policy and payment changes is available at:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-10-31-7.html?DLPage=1&DLSort=0&DLSortDir=descending.

The CMS fact sheet on physician quality program changes is available at:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-10-31-6.html.

The CMS fact sheet on the physician value-based payment modifier is available at:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-10-31-5.html.

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY 2015; Final Rule, 79 Fed. Reg. 67547, 67547 -68010 (Nov. 13, 2014).

Centers for Medicare & Medicaid Services.  “Policy and Payment Changes to the Medicare Physician Fee Schedule for 2015.”  Fact Sheet.  31 Oct. 2014.

Centers for Medicare & Medicaid Services.  “Changes for Calendar Year 2015 Physician Quality Programs and Other Programs in the Medicare Physician Fee Schedule.”  Fact Sheet.  31 Oct. 2014.

Centers for Medicare & Medicaid Services.  “Changes for the Physician Value-based Payment Modifier in the CY 2015 Medicare Physician Fee Schedule Final Rule.”  Fact Sheet.  31 Oct. 2014.

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