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Archive for November, 2016

2017 Medicare Physician Fee Schedule Final Rule Issued

Wednesday, November 2nd, 2016

The Centers for Medicare & Medicaid Services (CMS) has issued its final rule for the Medicare physician fee schedule (MPFS) for calendar year 2017. After application of the 0.5% payment increase, as 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. The final CF for CY 2017 is $35.8887,    up from the current CF of $35.8043.

CMS also 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. In addition, it will expand the Center for Medicare & Medicaid Innovation Diabetes Prevention Program model. CMS also finalized a number of new codes to more accurately pay for primary care, care management and other cognitive specialties.

The rule finalizes changes to the quality measurement requirements of the Medicare Shared Savings Program (MSSP), which includes revisions to the measure set and quality data validation process. This change will allow eligible individual professionals participating in MSSP to report quality data separately for the purposes of the Physician Quality Reporting System (PQRS), and to have that data used in PQRS in the event the MSSP Accountable Care Organization fails to report quality data.

The final rule can be found at https://federalregister.gov/d/2016-26668

2017 HOPPS/ASC Final Rule Released

Tuesday, November 1st, 2016

On November 1, the Centers for Medicare & Medicaid Services (CMS) finalized updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2017. CMS estimates that the updates in the final rule would increase OPPS payments by 1.7 percent and ASC payments by 1.9 percent in 2017.

The rule finalizes the removal of the pain management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey for purposes of the Hospital Value-Based Purchasing Program. However, CMS continues to believe that pain control is an appropriate part of routine patient care that hospitals should manage, and is an important concern for patients, their families, and their caregivers. CMS is continuing the development and field testing of alternative questions related to provider communications and pain, and will solicit comment on these alternatives in future rulemaking.

CMS is finalizing policies which require that certain items and services furnished by certain off-campus hospital outpatient departments will no longer be paid under the OPPS beginning January 1, 2017. The rule describes which off-campus hospital outpatient departments are subject to this requirement, and which items and services are “excepted” these payment changes, thus continuing to be paid under the OPPS.

Additionally, CMS is making changes under the Medicare EHR Incentive Program for eligible hospitals and critical access hospitals attesting to CMS, including hospitals that are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs (dual-eligible hospitals), by eliminating the Clinical Decision Support (CDS) and Computerized Order Entry (CPOE) objectives and measures beginning in 2017. CMS is reducing a subset of thresholds for the remaining objectives and measures for Modified Stage 2 and Stage 3. Additional changes include allowing all returning participants in the EHR Incentive Programs to report on a 90-day EHR reporting period in 2016 and 2017. CMS is also finalizing an application process for a one-time significant hardship exception to the Medicare EHR Incentive Program for certain eligible professionals in 2017 who are also transitioning to MIPS. These additions both increase flexibility, lower the reporting burden for providers, and focus on the exchange of health information and using technology to support patient care.

The OPPS/ASC Final Rule and Interim Final Comment (IFC) are available at:https://www.federalregister.gov/documents/2016/11/14/2016-26515/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment

Medicare RAC Contracts Named

Tuesday, November 1st, 2016

The Centers for Medicare & Medicaid (CMS) has named its new Medicare Recovery Audit Contractors (RAC). Three contractors will perform post-payment review of Medicare Part A and B fee-for-service claims for all provider types other than home health/hospice and Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). The contractors are Performant Recovery Inc. in Region 1, Cotivit LLC in Regions 2 and 3, and HMS Federal Solutions in Region 4. In addition, Performant Recovery will perform post-payment review of home health/hospice and DMEPOS claims nationally.

The announcement can be found by visiting


Final FY 2017 Hospital VBP Program Adjustment Factors Posted

Tuesday, November 1st, 2016

On November 1, the Centers for Medicare & Medicaid Services (CMS) posted the final incentive payment adjustment factors for the fiscal year (FY) 2017 Hospital Value-Based Purchasing Program (VBP). These factors are being used to adjust base operating Medicare Severity Diagnosis-Related Group (MS-DRG) payments to eligible hospitals for discharges this fiscal year. The base operating MS-DRG payments to eligible inpatient prospective payment system hospitals are being reduced by 2% in FY 2017 to fund an estimated $1.8 billion in incentive payments for the VBP program. The actual VBP amount earned by each hospital depends on its Total Performance Score and incentive payment percentage.

The CMS Factsheet can be found at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-11-01.html