The Centers for Medicare & Medicaid Services (CMS) finalized the Medicare physician fee schedule (PFS) for 2016. The final rule:
- Sets 2016 Medicare payment rates for physician services, including a 0.5% payment increase as a result of SGR repeal under the Medicare Access and CHIP Reauthorization Act (MACRA). However, despite objections from MGMA, CMS nullified the increase and reduced the 2016 conversion factor as a result of its misvalued code initiative. The CY 2016 PFS conversion factor is $35.8279. The CY 2016 national average anesthesia conversion factor is $22.3309;
- Establishes criteria for the 2016 performance year for the value-based payment modifier (VBPM), which could result in penalties of 4% in 2018 for high cost/low quality providers;
- Details criteria for 2016 performance in PQRS to avoid a 2% penalty in 2018;
- Increases the amount of information about physicians and practices on the Physician Compare website, including information pertaining to quality measure performance; and
- Clarifies billing guidance for incident-to services without any major changes.
In a separate rule, CMS finalized changes to policies and payments regarding hospital outpatient and ambulatory surgical centers.Visit the Federal Register to view the full final 2016 Medicare PFS. CMS also released a fact sheet on the final PFS. MGMA will analyze this extensive final rule and provide a detailed analysis as a member benefit in the coming weeks. Contact MGMA government affairs with questions by emailing email@example.com or calling 202.293.3450, 877.275.6462 toll-free.