CMS finalizes physician fee schedule for 2016: 10 things to know

CMS released its final 2016 payment rule for physicians on Friday, which includes a provision that will establish payment rates for end-of-life care planning.

Here are 10 things to know about the physician fee schedule for 2016, which is the first final rule issued since the repeal of the sustainable growth rate formula by the Medicare Access and CHIP Reauthorization Act of 2015.

Advance care planning
1. Consistent with recommendations from the American Medical Association and other stakeholders, the 2016 rule establishes separate billing codes and rates for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners — a change that was proposed in July.

2. Advance care planning is currently covered under a "Welcome to Medicare" visit available to all Medicare beneficiaries. However, beneficiaries may not need these services when they first enroll. "Establishing separate payment for advance care planning codes provides beneficiaries and practitioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families," said CMS.

3. CMS is also finalizing payment for advance care planning when it is included as an optional element of the "Annual Wellness Visit."

Value-Based Payment Modifier
4. Under the Value-Based Payment Modifier program, physicians can receive payment incentives for providing high-quality, efficient care, while those who underperform may be subject to a downward payment adjustment.

5. The 2016 rule finalizes a proposal to apply the Value Modifier to nonphysician eligible professional groups such as physician assistants and nurse practitioners, beginning with the calendar year 2018 payment adjustment period.

Physician Compare
6. The physician fee schedule for 2016 contains several changes to the Physician Compare website, including the use of star ratings.

7. "Benchmarks are important to ensuring that the quality data published on Physician Compare are accurately understood," said CMS. On Physician Compare, the benchmark would be displayed as a five-star rating under the final rule.

8. CMS is not finalizing the proposal to include a visual indicator on profile pages for group practices and individual providers who received payment bonuses for the Physician Value-Based Payment Modifier.

Stark Law
9. The rule establishes a new exception to the physician self-referral law to permit hospitals, federally qualified health centers and rural health clinics to make payment to physicians for the purpose of compensating nonphysician practitioners under certain conditions.

10. The 2016 rule also finalizes a new exception permitting timeshare arrangements for the use of office space, equipment, personnel, items, supplies, and other services.

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