Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Recapping Finalized 2015 Rules from CMS on Medicare Payments

By Ryan Mcaskill

Several new rules for 2015 have been finalized and will have an impact on how Medicare pays major health care providers.

- Payers and providers in the Medicare program need to take notice of new rules that the Centers for Medicare and Medicaid Services (CMS) finalized last week. They impact how major health care providers and suppliers will get paid from Medicare starting in 2015. Important provisions to the Affordable Care Act reward higher quality, patient-centered care at a lower cost.

The new rules include Medicare payments to physicians and non-physician practitioners, hospital outpatient departments, ambulatory surgical centers, home health agencies and dialysis facilities that treat patients with end-stage renal disease. It reflects a broader Administration-wide strategy to move our health care system to one that values quality over quantity and spends taxpayer dollars more wisely by finding better ways to deliver care, pay providers and distribute information.

“Health care systems across the country are shifting their focus from volume of services to better health outcomes for patients, coordinating care, and spending dollars more wisely,” CMS Administrator Marilyn Tavenner, said in the press release. “These rules are a part of the broader strategy driving greater value in health care. By collaborating and building on best practices across the health care system, we can deliver the results of higher quality care and lower costs that consumers, providers, purchasers, and businesses deserve.”

Recapping the changes

Coordinated care and new models – One new rule will see the Medicare Physician Fee Schedule to include a new chronic care management fee. This separate payment for chronic care management will support physician practices in their efforts to coordinate care for medicare beneficiaries with multiple chronic conditions. This helps improve the way care is provided by supporting clinicians coordinated care for patients.

Paying for quality – 2015 will continue to phase out fee-for-service in favor of a Value-based Payment Modifier. These adjust traditional Medicare payments to physicians and other eligible professionals based on quality and cost of care provided to beneficiaries. This translates to payment increases to providers with a track record of higher quality and penalized those that underperform.

Providing incentives – The Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS) rule includes provisions that promote greater packaging or payments for items and services rather than making separate payments for each individual service.

Better information sharing – CMS will release Quality and Resource Use Reports that will include new information about scope, cost and quality of care that is delivered to the Medicare beneficiaries they serve, both inside and outside of their practices.

Expand Physician Compare website – The site allows consumers to search for reliable information about physicians and other health care professional who provide Medicare services. This allows consumers to better pick the best option for the care they require. The expansion includes more public reporting including patient experience measures and measures collected by Qualified Clinical Data Registries.

Measure for dialysis facilities – The End-Stage Renal Disease (ESRD) Prospective Payment System rule introduces new quality and performance measures for outpatient dialysis facilities.



Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...