2016 Proposed MPFS Includes Several Changes

2016 Proposed MPFS Includes Several Changes

By Brenda Edwards, CPC, CPB, CPMA, CPC-I, CEMC, CRC

The Medicare Physician Fee Schedule (MPFS) pays for services furnished by providers in all places of services. It is updated annually by Centers for Medicare & Medicaid Services (CMS), and takes effect on or after January 1 of each year. Are you familiar with changes that might be coming? Here are a few things you might want to keep your eye on, for next year.

  • This is the first proposed rule since the Sustainable Growth Rate (SGR) was repealed, which means the SGR formula will no longer apply; physicians will see an across-the-board 0.5 percent increase.
  • Physician Compare, a website for patients to find physicians and health care professionals enrolled in Medicare, could see new policies to include making all individual and group-level PQRS measures available for public reporting. There are new policies proposed, including an indicator for Cardiovascular Prevention. Also, the proposal would establish a benchmark that would allow consumers to evaluate published information by providing a comparison between groups and between individuals which would be displayed on Physician Compare as a five star rating system.
  • Advance care planning services could see a separate payment for advance care planning codes. These codes would be used to report planning sessions at the appropriate time for the patient and family instead of including them in the “Welcome to Medicare” visit, allowing more flexibility when the planning sessions would be used.
  • A proposal to review mis-valued codes to establish a uniform approach to valuation. This could include:

o Services that currently include moderate sedation
o Radiation therapy
o Lower GI endoscopy services
o Potentially mis-valued anesthesia procedure codes

Anesthesia and Pain Management CANPC

  • Clarification of incident-to rules if the billing physician/practitioner must also be the supervising physician/practitioner. Additionally, the rule could require that auxiliary personnel providing incident-to services and supplies have not been excluded from Medicare, Medicaid or other federal healthcare program by OIG.
  • PQRS/Value based payment modifier program should see the same policies as last year with few modifications. The proposal would suggest using the calendar year (CY) 2016 as performance period for CY 2018 Value Modifier.

The full, proposed Medicare Physician Fee Schedule for 2016 can be reviewed here.  The final rule should be available around November 1st, with the changes taking effect on or after January 1, 2016.

Brenda Edwards

Brenda Edwards

Senior Managing Consultant of Risk Adjustment at Medical Revenue Solutions
Brenda Edwards, CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC, CMRS, CMCS, is executive consultant of risk adjustment at SCBI. She has for over 30 years with experience in chart audit, coding and billing, education, consulting, practice management, and compliance. Edwards shares her expertise writing for Healthcare Business Monthly, as well as other national publications, such as American Academy of Family Physicians (AAFP) and BC Advantage. Edwards helps students obtain their coding credentials through the AAPC Professional Medical Coding Curriculum, and she is an AAPC ICD10-CM/PCS Training Expert. Edwards served on the AAPC Chapter Association Board of Directors from 2010-2014 and held office as chair. She has been involved in the Hardship Fund for AAPC since its inception. Edwards is a mentor and co-founder of the Northeast Kansas (NEKAAPC) AAPC chapter and has served many officer roles.
Brenda Edwards

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Brenda Edwards, CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC, CMRS, CMCS, is executive consultant of risk adjustment at SCBI. She has for over 30 years with experience in chart audit, coding and billing, education, consulting, practice management, and compliance. Edwards shares her expertise writing for Healthcare Business Monthly, as well as other national publications, such as American Academy of Family Physicians (AAFP) and BC Advantage. Edwards helps students obtain their coding credentials through the AAPC Professional Medical Coding Curriculum, and she is an AAPC ICD10-CM/PCS Training Expert. Edwards served on the AAPC Chapter Association Board of Directors from 2010-2014 and held office as chair. She has been involved in the Hardship Fund for AAPC since its inception. Edwards is a mentor and co-founder of the Northeast Kansas (NEKAAPC) AAPC chapter and has served many officer roles.

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