CMS Issues 2015 Proposed Rules for the Medicare Physician Fee Schedule and Hospital Outpatient/Ambulatory Surgical Centers
Last week, CMS released the proposed 2015 Medicare Physician Fee Schedule (MPFS) and 2015 Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Centers (ASCs) proposed rules. In its 2015 MPFS Proposed Rule, CMS is proposing a new more transparent process for establishing PFS payment rates that will allow for more public input prior to finalizing rates. Under the new process, payment changes will go through notice and comment rulemaking before being adopted beginning for 2016 In addition, CMS is proposing changes to several quality reporting initiatives, changes to the Physician Compare Website and to continue phasing in of the Value Based Payment Modifier. For more on the proposed rule, see the CMS Fact Sheet on the Rule.
Under its 2015 Proposed Rule for the HOPPS and ASC payment systems, CMS is proposing to move forward with its comprehensive APC policy which was delayed until 2015, to begin collecting data on off-campus provider-based departments by requiring use of a modifier for these services, and to modify quality measures used for reporting in the ASC and outpatient settings . For more, see the CMS Fact Sheet on the Rule.
CMS Announces Release of Unprecedented Public Access to Data (4/8/2014)
Recently, the Centers for Medicare & Medicaid Services (CMS) stated it would allow public access to physicians’ Medicare Part B 2012 data, including access to the number and type of health care services, number of unique beneficiaries, average submitted charges, and average amount of money paid by Medicare for those services. While the Academy, along with other specialties, support the concept of transparency related to data, we cautioned that providers should have the opportunity to review their data prior to be in becoming public.
Coding Update: New CMS G-Code/Modifier Requirements for Therapy Services (3/13/2014)
Last year, CMS finalized several key changes to reporting requirements regarding therapy services. Specifically, CMS implemented a claims-based data collection strategy to collect data on patient function, which impacts key services provided by Otolaryngologists. CMS defines “therapists” as all practitioners who furnish outpatient therapy services. Under this policy, claims for therapy services must now include non-payable G-codes and modifiers, which will allow the agency to capture data on the beneficiary’s functional limitations at various points during the provision of therapy. For therapy services being furnished that are not intended to treat a functional limitation, the therapist should use the G-code for “other” and the modifier representing zero. For a full summary of the issue, click here.