Federal CMS releases Medicare final rule

Tuesday, December 17, 2013 03:20 PM

The Centers for Medicare and Medicaid Services has released its payment rates and policies for 2014, outlining policy on a range of payment-related topics. Most provisions take effect Jan. 1, though a few remain open for public comment until Jan. 27. The American Medical Association highlighted several of the provisions in an executive summary.

• A proposed cap on non-facility practice expenses will not take effect. The federal CMS did not finalize its plan to cap payments for more than 200 physician services at rates previously set for ambulatory surgery centers or hospital outpatient departments.
• Physician Quality Reporting System incentives will end in 2014. Beginning in 2015, physicians will receive monetary penalties for failing to satisfactorily report. Under the final rule, physicians will need to report on 50 percent of applicable patients, instead of 80 percent.
• $435 million will be redistributed within the Medicare Physician Fee Schedule in 2014. CMS accepted 76 percent of the recommendations by the AMA/Specialty Society Relative Value Scale Update Committee, including improved payment for mental health services. CMS will pay monthly chronic care management services beginning in 2015. Estimates place these payments at about $82 per Medicare patient per month.
• The value-based payment modifier will apply to groups of 10 or more in 2016. Group practices of 10 or more physicians and other health care professionals will receive a yet-to-be-determined payment increase for performing well on cost and quality measures in 2014. Groups that do not perform well, meanwhile, could face a cut of up to 2 percent in their 2016 payments. The AMA and others objected to this expansion; CMS is not required to apply the VBM to all physicians until 2017.

Click here to read the AMA’s 12-page executive summary to learn more about these and other policy updates in the 2014 Medicare Physician Fee Schedule final rule.