CMS issues proposed 2015 Medicare payment rule August 4, 2014 Medi-Cal, Medicare Insurance/Reimbursement, Medicare, Centers for Medicare and Medicaid Services 0 The Centers for Medicare and Medicaid Services (CMS) recently published the 2015 proposed Medicare physician payment rule in the Federal Register. The proposal contains several notable changes. The rule expands the services eligible for telemedicine reimbursement (psychotherapy services and the annual wellness visit). It also extends the new payment policies for non-face-to-face care coordination. It allows primary care physicians to be paid for care management of Medicare beneficiaries with two or more chronic conditions. These are tasks (including managing lab and imaging reports, medications and care plans in addition to talking with patients and families on the phone) physicians commonly provide, but have not been paid for in the past. In a radical move, the rule proposed the elimination of all 10- and 90-day global surgical packages by 2018 because CMS says it lacks the ability to verify the number, type and relative costs of postoperative visits. Packages would only include preoperative services and care given the day of surgery. The American Medical Association (AMA) and the California Medical Association (CMA) are protesting this proposal. CMS also continues to move up the implementation timeline for the Value-Based Payment Modifier. Physician groups of 100 or more will be eligible for the Value-Based Payment Modifier (VBM) penalties or bonuses in 2015 based on 2013 cost and quality performance. Groups of 25 to 100 physicians will be eligible in 2016 based on 2014 performance. The program will be expanded to all physicians in 2017 based on performance in 2015 and penalties will be doubled to 4 percent. To get an idea of how they are likely to score in the VBM, physicians should review the confidential feedback reports that were also required by law and are known as Quality and Resource Use Reports (QRURs). Reports based on 2012 data became available to groups of 25 or more last fall and are still open for review. Starting in the fall of 2014, reports based on the prior year’s data will be made available for all physician groups as well as solo physicians. AMA and CMA have called for a slower phase-in of the VBM. CMA is supporting the VBM program reforms in the Medicare sustainable growth rate (SGR) overhaul legislation (HR 1415/S 2000), which includes large bonus payments. There are also new requirements for the Physician Quality Reporting System (PQRS) and a continuation of the 2 percent penalty. CMS reiterated its support for legislation to permanently repeal the Medicare SGR formula. Legislation passed earlier this year to prevent SGR physician pay cuts through March 2015. CMS projects that payments would be reduced by 20.9 percent when the patch expires on March 31, 2015. Comments are due on Tuesday, September 2, with a final rule to be issued on or around November 1, for implementation on January 1, 2015. CMA and AMA will be submitting extensive comments. To view the AMA summary of the whole 2015 Medicare physician fee schedule, click here. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. Comments are closed.
