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From Health Law Daily, November 13, 2014

CMS releases final rule on 2015 Part B payments

By Michelle L. Oxman, JD, LLM

CMS has released a Final rule with comment period to finalize payment rules for the Physician Fee Schedule (PFS), Clinical Laboratory Fee Schedule, and ambulance services, and to make changes to physician quality reporting and the Physician Compare website (Final rule, 79 FR 67548, November 13, 2014).

PFS changes. CMS is continuing the process of examining potentially misvalued codes as required by Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) sec. 3134 and expanded by sec. 220 of the Protecting Access to Medicare Act (PAMA) (P.L. 113-93) and revising them. The PAMA sets a target reduction of 0.5 percent of spending on the misvalued codes and directed CMS to examine nine categories of codes that are high-cost for various reasons or for which payment depends on the site of service. It has postponed the proposal to change to one payment rate for both digital and film mammography, however, in response to comments. The codes for prostate screening and related surgery and several other procedures will be modified.

Revision and refinement. The proposals to change about 80 proposed as interim codes in the 2014 Final rule were largely finalized. Several that related to specific surgical procedures were deferred and discussed at length.

Telehealth services. CMS has added several services to the list of services eligible for telehealth, including the annual wellness visit, psychotherapy, including family psychotherapy, and prolonged office service. It will consider more proposed additions as it prepares the 2016 PFS rule.

Open payments. CMS has deleted the definition of “covered device” from 42 CFR sec. 403.902. It also has modified the rule excluding payments to speakers at continuing education events to permit exclusion only when: (1) the sponsoring manufacturer has no input into the selection of the speaker; (2) the manufacturer does not pay the speaker directly; and (3) the program is certified by one of several medical associations, such as the Accreditation Council for Continuing Medical Education, the American Academy of Family Physicians, the American Medical Association, or the American Osteopathic Association. The rule also will require the reporting of stock options and other ownership interests in distinct categories.

Quality reporting and Physician Compare. CMS will expand the measures on which physicians may report, as proposed and as discussed in the 2014 Final rule. It will not include the first year’s data on the Physician Compare web site, however, so that physicians can learn from the data.

Other matters. The changes to the ambulance payments are required by statute and self-implementing. No changes to the clinical laboratory fee schedule were finalized.

MainStory: TopStory ReimbursementNews PartBNews PhysicianNews HITNews EHRNews CMSNews QualityNews

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