Annual Update to the Physician Fee Schedule

By Baker Newman Noyes August 9, 2015

The Centers for Medicare and Medicaid Services (CMS) has issued an update for Calendar Year 2016 to the Payment Policies under the Physician Fee Schedule and Other Revisions to Part B in a proposed rule dated July 15, 2015 (CMS 1631-P).

The Social Security Act requires that CMS update the Physician Fee Schedule to account for the sensitivity of the number of components that make up the composite payments. Through a variety of analytics, a relative value unit is developed to account for national market adjustments to work and practice expense, malpractice expense, reflective geographic pricing disparities as well as other changes to the statutes.

In a major 260 plus page release, CMS has also commented upon or proposed changes to the following:

• Potentially misvalued PFS Codes
• Telehealth Services
• Advance Care Planning Services
• Establishing Value for new, revised and misvalued codes
• Target for RVU adjustments for misvalued services
• Phase-in of significant RVU reductions
• “Incident to” policy
• Portable x-ray transportation fee
• Updating the Ambulance Fee Schedule regulations
• Changes in Geographic Areas delineations for Ambulance Payment
• Chronic Care Management Services for RHCs and FQHCs
• HCPCS Coding for RHCs
• Payment to grandfathered Tribal FQHCs that were Provider-Based Clinics on or before April 7, 2000
• Payment for Biosimilars under Medicare Part B
• Physician Compare Web site
• Physician Quality Reporting Systems
• Medicare Shared Savings Program
• Electronic Health Records Incentive Program
• Value-Based Payment Modifier and the Physician Feedback Program

If you would like to discuss these matters further, contact your BNN advisor at 1.800.244.7444.