CMS Issues Final Rule on Physician Payment

The Centers for Medicare and Medicaid Services (CMS) late Friday issued a final rule for physician reimbursement under Medicare in 2015. The final rule is similar to the proposed rule that CMS issued in July, with a few modifications. For example, CMS had proposed a payment rate of $41.92 for its chronic care management code, but the rate was changed to $40.39 in the final rule.

In terms of the sustainable growth rate (SGR) formula for physician reimbursement, the agency notes that the Protecting Access to Medicare Act of 2014 "provides for a 0% PFS [physician fee schedule] update for services furnished between Jan. 1, 2015 and March 31, 2015," staving off for 3 months the 21.2% cut mandated by the SGR formula.

"In most prior years, Congress has taken action to avert a large reduction in PFS rates before they went into effect," CMS noted. "The Administration supports legislation to permanently change SGR to provide more stability for Medicare beneficiaries and providers while promoting efficient, high-quality care."

The final rule also makes some changes to several of the quality 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 website. The rule also continues the phased-in implementation of the physician value-based payment modifier (Value Modifier), created by the Affordable Care Act, that would affect payments to physicians and physician groups, as well as other eligible professionals, based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare fee-for-service program.