CMS releases final 2017 physician payment rule

The Centers for Medicare & Medicaid Services late today issued its final rule for the physician fee schedule for calendar year 2017. After application of the 0.5% payment increase required by the Medicare Access and CHIP Reauthorization Act of 2015 and mandated budget neutrality cuts, physician payment rates will increase 0.24% for 2017 compared to 2016. In addition, CMS finalized its proposals to pay for new telehealth services, including end-stage renal disease-related services for dialysis, advance care planning services and critical care consultations, and to expand the Center for Medicare & Medicaid Innovation Diabetes Prevention Program model. The agency also finalized a number of new codes to more accurately pay for primary care, care management and other cognitive specialties, including separate payments to primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions. With respect to Medicare Advantage, CMS finalized its proposals to require health care providers and suppliers to be screened and enrolled in Medicare in order to contract with an MA organization for purposes of providing items and services to Medicare beneficiaries. This provision will begin two years after publication of the final rule and will be effective on the first day of the plan year. The agency also finalized routine releases of two new data sets: one which includes certain MA bid information that is at least five years old, and another with MA and drug plans’ medical-loss ratios. Other proposals finalized by CMS include changes to the quality measurement requirements of the Medicare Shared Savings Program, including revisions to the measure set and quality data validation process; a change to allow individual eligible professionals participating in MSSP to report quality data separately for the purposes of the Physician Quality Reporting System, and to have that data used in PQRS in the event the MSSP Accountable Care Organization fails to report quality data; and updates to the informal review process used in the physician value modifier program. AHA members will receive a Special Bulletin with further details tomorrow.