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  • Washington Highlights

    CMS Releases CY 2017 Physician Fee Schedule Final Rule

    Len Marquez, Senior Director, Government Relations

    The Centers for Medicare and Medicaid Services (CMS) Nov. 2 released the calendar year (CY) 2017 Physician Fee Schedule (PFS) final rule that updates payment rates and other payment policies for services provided by physician and other health care professionals paid under the PFS. This rule addresses physician policies not impacted by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which was addressed in separate rulemaking.

    Key provisions include an update to the conversion factor, reduction in reporting burden for the data collection strategy for global services, updates to the Medicare Shared Savings Program (MSSP), and the addition of several billing codes to better account for primary care and care management services.

    CMS finalized misvalued code changes that achieve a 0.33 percent in net expenditure reductions. These changes would not meet the misvalued code target of 0.5 percent, setting the 2017 PFS conversion factor at $35.89 — a slight increase from the 2016 conversion factor of $35.80.

    In response to concerns raised by the AAMC [see Washington Highlights, Sept. 9] and others on the proposal, CMS finalized a data collection strategy for global services that significantly reduces the reporting burden associated with the proposed rule in the following ways:

    • Claims reporting of post-operative visits will be required only for high volume/high cost procedures instead of all global services. High volume/high cost procedures will be defined as services that are furnished by more than 100 practitioners and are either furnished more than 10,000 times or have allowed charges of more than $10 million annually.
    • CPT code 99024 will be used to report post-operative visits instead of the proposed global surgery codes (G-codes), which would have required reporting 10 minute time increments and levels of intensity.
    • Reporting will only be required for a sample of practitioners in practices of 10 or more in specified states instead of all practitioners as proposed.
    • Practitioners who are required to report would need to do so for services furnished on or after July 1, 2017, instead of Jan. 1, 2017.
    • Teaching physicians will be subject to the reporting requirements in the same way as other physicians and should use the GC or GE modifier as appropriate to indicate the involvement of residents.

    CMS also finalized several policies regarding the MSSP and updated the quality reporting requirements, including changes to the measure sets and other updates to align with the final Quality Payment Program. CMS also modified the Accountable Care Organization (ACO) attribution methodology to allow the beneficiary to designate an ACO professional as responsible for their overall care.

    Additionally, CMS finalized revisions to the PFS billing codes to improve payment accuracy for primary care, care management, and cognitive services. CMS reduced administrative burden associated with chronic care management codes to improve health care delivery.

    Other finalized policies include the expansion of the Medicare Diabetes Prevention Program and payment for mammography services.

    The AAMC will be hosting a webinar on the final rule and will be providing additional resources to assist members in implementing changes.