Late on July 3, 2014, the Centers for Medicare & Medicaid Services (CMS) issued the Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, the Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare & Medicaid Innovation Models, & Other Revisions to Part B for CY 2015 (PFS) Proposed Rule effective for services on and after January 1, 2015. The proposed rule will be published in the Federal Register on July 11, 2014. CMS will accept comments on the proposed rule until September 2, 2014. To view the proposed rule, please visit the Federal Register Public Inspection Desk at https://www.federalregister.gov/public-inspection. CMS' Fact Sheet can be viewed here.
The Proposed Rule includes changes to the misvalued CPT code review process as well as several of the reporting initiatives that are associated with PFS payments the Physician Quality Reporting System (PQRS), Medicare Shared Savings Program and Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare tool on Medicare.gov. The proposed rule also continues the phased-in implementation of the physician value-based payment modifier. The modifier provides differential payments to physicians based on comparison of the quality of care furnished to beneficiaries and the cost of care.
The following is an overview of the proposed policy and payment changes to the Medicare Physician Fee Schedule for Calendar Year 2015 of interest to NASL members.
Sustainable Growth Rate (SGR)
Although Medicare physician and Part B provider pay rates are due to be cut by at least 20 percent under the SGR, the proposed rule does not include proposals or announcements on the PFS update or SGR as these calculations are determined under a prescribed statutory formula that cannot be changed by CMS. The final figures are announced in the final rule in November. The Protecting Access to Medicare Act (PAMA) of 2014 provides for a zero percent PFS update for services furnished through March 31, 2015.
Potentially Misvalued Services Under the PFS
CMS has been engaged in a multi-year effort to identify and review potentially misvalued codes and to make adjustments where appropriate. In this year’s proposed rule, CMS is proposing to add about 80 codes to its list of potentially misvalued codes, 65 of which account for the majority of spending under the Physician Fee Schedule. CMS identified codes by reviewing high-expenditure services by specialty that have not been recently reviewed. Codes under review include those used in therapy such as 97032 Electrical stimulation, 97035 Ultrasound therapy, 97110 Therapeutic exercises, 97112 Neuromuscular reeducation, 97113 Aquatic therapy/exercises, 97116 Gait training therapy, 97140 Manual therapy 1/> regions, 97530 Therapeutic activities and G0283 Elec stim other than wound.
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