With the release of a nearly 1,360-page final rule, the Centers for Medicare & Medicaid Services (CMS) has issued the policies that will govern physicians’ Medicare payments in 2016. From the comprehensive list of updates, we’ve identified five particularly noteworthy changes you should know.
Payment rates will drop slightly
The conversation factor that is used to calculate physician payment rates for the year was influenced by no less than three different laws. With the 0.5 percent payment update from the Medicare Access and Chip Reauthorization Act (MACRA) included, next year’s conversion factor will be $35.83—down 10 cents from 2015.
Advanced care planning will be a covered service
Medicare will begin paying for two CPT codes for advanced care planning services, which include conversations between patients and their physicians before an illness progresses and during treatment. Previously, advanced care planning only was covered as part of the “Welcome to Medicare” visit for new enrollees.
The new payment policy, adopted at the AMA’s recommendation, recognizes both the additional time that is needed to conduct these important conversations and provides the flexibility to hold these planning sessions at the most appropriate time for patients and their families.
“Incident to” services will not be restricted to certain professionals
A proposed change to the regulatory language about who would be able to bill for incident to services threatened to let Medicare administrative contractors and auditors prohibit billing by a supervising physician who wasn’t managing the patient’s overall care.
The AMA pointed out in a comment letter (log in) to CMS that such a change would have posed serious problems to group practices and multispecialty clinics that provide recurring treatments that often are not supervised by the physician managing the care. Accordingly, CMS has issued modified language, making it clear that such services do not need to be supervised by the same physician who is “treating the patient more broadly.”
The requirement to consult appropriate use criteria has been delayed
Under the Protecting Access to Medicare Act of 2014, physicians who order advanced diagnostic imaging services must consult appropriate use criteria via a clinical decision support mechanism. CMS has not yet specified the appropriate use criteria that must be followed, the mechanisms that must be consulted or developed a prior authorization program as required, so the agency has delayed the consultation requirement that would have taken effect Jan. 1, 2017.
CMS also is considering the AMA’s recommendation to exclude emergency departments from this consultation requirement so they can swiftly provide necessary urgent care.
Opting out of Medicare won’t require biennial renewals
In the past, physicians who have wished to renew their opt-out status were required to file new valid affidavits with their Medicare administrative contractors every two years. Thanks to a provision in the MACRA, physicians who filed valid opt-out affidavits on or after June 16, 2015, will not need to file renewal affidavits.
The only action required will be if these physicians choose to cancel their opt-out status. In that case, they simply will need to provide written notice to the Medicare administrative contractors with which they have filed an affidavit at least 30 days before the start of the new two-year opt-out period.
Learn more about these policy changes and others from the 2016 Medicare Physician Fee Schedule final rule in an AMA synopsis (log in).
