The Centers for Medicare & Medicaid Services’ (CMS’s) proposed rule for the 2014 Medicare Physician Fee Schedule (MPFS) includes updates in payment policies related to chronic care management, telehealth, geography-based cost adjustments and the Physician Quality Reporting System (PQRS). CMS will accept comments until September 6 on the proposed rule and will respond to them in a final rule with comment period to be issued on or about November 1.
Notably, CMS has proposed to pay for non-face-to-face complex chronic care management services for Medicare beneficiaries who have two or more significant chronic conditions. Proposed changes to the PQRS reflect CMS’s intention to use PQRS data to support its rollout of the physician value-based modifier and the Physician Compare website.
In addition, the period of unreimbursed evaluation and management (E/M) care may be ending for hundreds of thousands of primary care physicians. Recognizing that care coordination may help keep health care costs in check for an aging population, CMS proposed reimbursing physicians for patient care-management activities that don’t involve face-to-face contact starting in 2015.
The 605-page proposed rule also recommends packaging services that previously were paid separately, such as clinical diagnostic laboratory tests (except molecular pathology) when provided on the same date of service as another service. This means the reimbursement for clinical diagnostic laboratory services, which currently are reimbursed under the Clinical Lab Fee Schedule, would be bundled into the reimbursement of the other services provided on the same day.
Changes to E/M coding and reimbursement for hospital outpatients, including provider-based clinics, also are proposed. Currently, hospitals report multiple levels of E/M CPT® codes for new patient clinic visits, established patient clinic visits and emergency department visits. Under the proposal, CMS would replace all of these codes with three new HCPCS G-codes. The G-codes would be assigned to three different visit reimbursement levels. These new G-codes would be intended for the facility, not the physician fees.
More information about the 2014 MPFS proposed rule is available in this CMS Fact Sheet. The Wisconsin Medical Society also is partnering with National Government Services (NGS) for its annual fall Medicare seminar in October. Mastering Medicare in 2014 is scheduled for October 29 in Madison, October 30 in Brookfield and October 31 in Green Bay. Details coming soon on the Society’s website.
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