MLR

Ready for impact of new CMS fee schedule?

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Physicians need to review how their practice might be affected by the 2015 Medicare Physician Fee Schedule to offset any negative consequence.

money and stethoscope

November 2014 is the deadline for the Centers for Medicare & Medicaid Services (CMS) to finalize its fee schedule.

The impact of the proposed changes on healthcare professionals is a mixed bag. The good news for family physicians and internal medicine practitioners is an estimated increase in total allowed charges of 2 percent next year.

But because of a planned reclassification of practice expense, specialties expected to be hit hard next year include radiologists (-2 percent), radiation oncologists (-4 percent) and radiation therapy centers (-8 percent).

Chronic care management

Much of the increase for family physicians and internal medicine practitioners is expected to come from the CMS proposal to pay separately for non-face-to-face chronic care management services for Medicare beneficiaries with two or more significant chronic conditions.

These services include regular development and revision of a plan of care, communication with other treating health professionals and medication management.

CMS has set reimbursement at $41.92. Physicians can bill the new code if they have provided at least 20 minutes of chronic care management services for a qualified patient. Billing is limited to once every 30 days per patient.

Work the clinical staff members do under general supervision of a physician counts toward the 20 minutes. Direct on-site supervision by a provider is not required.

As proposed, physicians must have a certified electronic health record (EHR) system that meets meaningful-use requirements to qualify for reimbursement.

Value-based modifier effect

All physicians who receive payments under the 2015 Medicare Physician Fee Schedule will be critically affected. They include solo practitioners, groups of two or more and other eligible professionals, such as physician assistants and nurse practitioners.

Their performance for the year will be judged against the Medicare Physician Quality Reporting System (PQRS) cost and quality measures. The results will determine whether they will be rewarded for their performance or penalized in 2017.

Under the value-based modifier program, solo practitioners and groups under 10 reporting data on PQRS quality measures will be eligible for a bonus but will not be subject to a penalty.

However, those who don’t participate in PQRS or are low-performing in 2015 could risk losing 4 percent of their payments in 2017. Therefore, CMS is urging small groups and solo practitioners to participate in PQRS now.

Large groups will feel the effect of the value modifier program in 2015.

Payments to physicians in group practices of 100 or more that submit claims under one tax identification number will be adjusted next year based on their 2013 performance. The value modifier will apply to both participating and non-participating Medicare physicians.

And in 2016, the value modifier will be applied to physicians in groups of 10 or more based on 2014 performance.

All groups and solo practitioners should review the recently disseminated CMS Quality and Resource Use Report.

Based on 2013 data, the report contains performance information on the quality and cost measures used to calculate the value modifier, and it provides physicians with some insight as to how they will fare under the program.

For a complete review of the final 2015 Medicare Physician Fee Schedule, visit the CMS website at www.cms.gov.