CMS Releases Final Rule for 2017 Physician Fee Schedule



Taking effect on January 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released its final rule for the 2017 Physician Fee Schedule. The revised regulations focus on reinforcing primary care, behavioral health and diabetes prevention. By providing physicians further incentive to practice quality care, the final rule for the 2017 Physician Fee Schedule will help beneficiaries access the services they need to stay well and live longer, healthier lives.

Background of the Physician Fee Schedule

Payment for services provided by physicians and other practitioners is made under the Physician Fee Schedule (PFS). These services include visits, surgical procedures, diagnostic tests, therapy services and preventive services. A variety of practitioners and facilities are also paid under the PFS, including nurse practitioners, physician assistants, physical therapists, and radiation therapy centers.

Under the PFS, payments are based on the relative resources used to provide the service. Relative value units are applied to each service for physician work, practice expense, and malpractice. These units become payment rates through the application of a conversion factor, which is updated each year.

Highlights of the CMS Final Rule

The CMS finalized and created several revisions in order to accurately recognize the evolving work of primary care and other behavioral specialties, accommodating the changing needs of Medicare patients. Below are some highlights of the changes the CMS made to the 2017 Physician Fee Schedule.

· Better Incentives for Collaborative Arrangements of Behavioral Health Care

Based upon the psychiatric Collaborative Care Model, CMS is establishing new codes that are designed to inspire and reward care that is delivered by a team comprised of both primary care physicians and behavioral health specialists.

· New Codes for Complex, Chronic Care Management

A significant update to the Physician Fee Schedule is new and revalued codes for chronic care management, which focuses on new codes covering care activities that take place after the first visit from a patient with multiple chronic conditions. The rule is designed to improve support for primary care practitioners. The CMS rule also now includes separate payments under a new code for assessing and planning care for patients with dementia or other behavioral issues.

· Medicare Diabetes Prevention Program Expanded

Starting in 2018, CMS expects Medicare beneficiaries to the have the ability to attend community-based programs intended to prevent the onset of diabetes through behavioral interventions. The CMS believes this will benefit patients and reduce the overall cost of care. They also hope that this will inspire employers and insurers to follow their lead and implement similar programs for their care populations.

Latest Industry Information at HIS

With new regulations to the Physician Fee Schedule by the CMS, it will hopefully create a health care system that results in quality care, better spending and healthier individuals. But if you are looking for more of the latest industry information – subscribe to our blog! At HIS, our blog will provide you with resources and educational information related to the industry and tips for practice efficiency. Contact us today for more information on our blog and services.