Policy & Regulation News

CMS Proposes Post-SGR Repeal Physician Fee Schedule Update

By Jacqueline DiChiara

- The Centers for Medicare & Medicaid Services (CMS) has released a projected update to the physician payment schedule. CMS’s proposal marks the first post-Sustainable Growth Rate (SGR) repeal through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s planned implementation of key payment legislation primarily concentrates on person-centered care and maintaining a responsibility to advance quality and healthy outcomes within the Medicare program.

physician payment schedule

CMS’s proposed rule contains a series of payment policy revisions and plans to implement statutory adjustments to physician payments in conjunction with misvalued codes. Additional updates are planned for the Physician Quality Reporting System, which evaluates the quality performance of Medicare-participating physicians. Also on CMS’s radar are updates to the Physician Value-Based Payment Modifier, which associates a segment of physician payments to performance based on cost and quality measures.

CMS-1631-P, an 815-page proposed rule, also addresses other Medicare Part B payment policies to ensure up-to-date payment systems that accurately mirror medical practices’ modifications and the value associated with various services.

CMS monitors the quality of care Medicare beneficiaries receive through the Physician Quality Reporting System and proposes changes to address measurement gaps or weaknesses present within the system. According to CMS, physician fee schedules pay for services that are provided by physicians and healthcare practitioners – such as office visits, surgical procedures, diagnostic tests, and therapy services. Physician fee schedules additionally ensure a variety of healthcare professionals –such as nurse practitioners, physician assistants, physical therapists, radiation therapy centers, and independent diagnostic testing facilities – are paid.

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  • “CMS is building on the important work of Congress to shift the Medicare program toward a system that rewards physicians for providing high quality care,” states Andy Slavitt, Administrator of CMS. “Thanks to the recent landmark Medicare and children’s health insurance program legislation, CMS and Congress are working together to achieve a better Medicare payment system for physicians and the American people,” he confirms. 

    CMS confirms a final rule will be published later this year. “CMS welcomes the input of stakeholders and the public,” the organization states, confirming the implementation of a 60-day comment period.

    “The proposed rule also seeks comment on a proposal that supports patient-and family-centered (sic) care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers,” CMS explains. “The proposal follows the American Medical Association’s recommendation to make advance care planning services a separately payable service under Medicare,” says CMS.

    This news is only part of a slew of proposed policies on behalf of CMS, many of which are directly connected to recently enacted legislation. As RevCycleIntelligence.com reported, many of these proposed physician fee schedule and payment policies from CMS suggest a wide variety of revisions related to various payment systems, Medicaid eligibility, mental health and substance use disorders, and critical access and acute care hospitals.