CMS Final Rule: Key Revisions To Medicare’s 2015 Physician Fee Schedule

Physicians have mixed feelings about the final rule CMS issued last week that includes Medicare’s 2015 physician fee schedule. The rule also revises the agency’s policies on telehealth and paying different rates for the same service depending on where it was delivered. However, physicians were the most concerned with the potential that physician payments will be subject to a 21.2% cut driven my Medicare’s sustainable growth-rate payment formula on April 1 (unless Congress decides against it).

One of the highlights of the rule is the creation of a monthly care-management fee for patients with two or more chronic conditions. CMS has set the fee at $42.50 and has “backed away” from the previously proposed requirement that only physicians using 2014 edition-certified software would be able to collect the fee. The new final rule allows physicians using 2011 edition EHRs to collect fees. Physicians are also commending CMS for rewarding care coordination. However, they are also expressing concern over the administrative burdens associated with documenting non-face-to-face management services that could outweigh the benefits of the new payment. They believe the care-coordination fee should be higher due to the level of work involved.

Key changes in the final rule include CMS taking action on the Medicare Payment Advisory Commission’s recommendation for site-neutral reimbursement for similar services delivered in different settings. MedPAC intends to make rates the same whether the patient is seen at hospital or a physician’s practice. CMS will “study the issue and create new codes designating whether services were provided off or on a hospital campus so it can examine the trends in Medicare payment and beneficiaries’ cost-sharing as hospitals acquire physician practices and bill services they deliver as hospital-based outpatient care.”

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