2015 proposed physician fee schedule, Part B revisions
By - On Friday, July 11, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule for its “Revisions to Payments Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B” policy.
The proposed rule addresses changes to the physician fee schedule (PFS) and other Medicare Part B payment policies. Any changes would be applied to services rendered in CY 2015.
Here is a quick rundown on the details of the proposed rule:
Resource based practice expense relative value units
Previously, the Medicare system relied on national relative values that are established for work, PE, and MP, which are adjusted for geographic cost variations. These values are multiplied by a conversion factor (CF) to convert the relative value units (RVUs) into payment rates. CMS proposes RVUs for CY 2015 for the PFS, and other Medicare Part B payment policies, ensuring that its payment systems are updated to reflect changes in medical practice and the relative value of services, along with changes in the statute.
Potentially misvalued services under the physician fee schedule
Additionally, the proposed rule will discuss misvalued services, including how to identify, review and validate the RVUs of potentially misvalued services. According to CMS stakeholders and the public may nominate potentially misvalued codes for review by submitting the code with supporting documentation during the 60-day public comment period after the release of the annual PFS final rule with comment period.
Additional provisions
The proposed rule will also discuss updates to the ambulance fee schedule regulations, as well as any changes to core-based statistical areas for ambulance payment. Telehealth services and chronic care management services will also be discussed and clarified by CMS.
Additionally, CMS will clarify updates to the Physician Compare website and its EHR Incentive Program. The Value-Based Payment Modifier and the Physician Feedback Program will also be clarified under the proposed rule.
Private contracting and opt-out determinations will also be clarified in CMS’ proposed rule, along with discussions on the effects of opting out of Medicare and applying to Medicare Advantage contracts.
Details on the Medicare Shared Savings Program will also be discussed, as well as any suggested changes to quality measures used in establishing quality performance standards that ACOs have to meet in order to be eligible for the Shared Savings Program.
Costs and benefits
Several of CMS’s proposed changes could affect the specialty distribution of Medicare expenditures. The most significant impacts would be for radiation therapy centers and radiation oncology, which would see decreases of 8 and 4 percent, respectively.
However, payment for chronic care management (CCM) services is projected to have a positive effect on family practice, internal medicine, and geriatrics. Additionally, for most specialties the proposed revisions for the five-year review of MP RVUs would result in minor overall changes in RVUs. According to CMS, just ophthalmology is projected to have a change of at least 2 percent – it is projected to have a 2 percent decrease.
