CMS to Revise Medicare Physician Fee Schedule to improve payment accuracy under 2017 MPFS proposed rule.
The Centers for Medicare & Medicaid Services (CMS) outlines plans to revise Medicare Physician Fee Schedule (MPFS) payment policies for 2017 and make several other policy changes related to Medicare Part B payment in a proposed rule.
Section II of the MPFS proposed rule majorly focuses on:
- Practice expense relative value units (PE RVUs),
- Malpractice relative value units (MRVUs) and
- Potentially misvalued services.
CMS intends to ?improve payment accuracy? for services like:
Primary care
Care management services
Patient-centered services
Preventive services (specifically, diabetes self-management training)
CMS used the American Medical Association?s Physician Practice Expense Information Survey (PPIS) data to update the practice expense incurred per hour worked for the 2010 MPFS for almost all Medicare-recognized specialties that participated in the survey. The payment reductions that resulted were transitioned over a four-year period. PE RVUs from 2013 forward are developed based entirely on the PPIS data.
CMS used an average of the three most recent years of available Medicare claims data to determine the specialty mix assigned to each code.
CMS is seeking comment on the proposed 2017 MPFS rates and whether or not the incorporation of a new year of utilization data into a three-year average mitigates the need for alternative service-level overrides, such as a claims-based approach or a stockholder-recommended approach in the development of PE RVUs and MRVUs for low-volume codes, because the proposed PE RVUs factor a new year of claims into the three-year average for the first time.
CMS is proposing 2017 values for new, revised, and potentially misvalued codes in the 2017 proposed rule, rather than establishing them as interim final in the final rule, as per the 2015 MPFS final rule. Beginning with this 2017 proposed rule, the new valuation process will be applicable to all codes, except for new codes that describe truly new services. Codes with established interim final values in the 2016 MPFS final rule are re-proposed in this 2017 proposed rule.
CMS is also proposing an aggressive data collection effort to accurately value the 4,200 codes with a 10- to 90-day global period. Beginning on or after Jan. 1, 2017, all practitioners who furnish a 10- or 90-day global service would be required to submit a claim(s) providing information on all services furnished within the relevant global service period.