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CMS Releases 2015 Final Rule on Physician Fee Schedule

Monday, December 08, 2014   (0 Comments)
Posted by: Becky Dryden
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On October 31, 2014 the Centers for Medicare and Medicaid Services (CMS) released its final rule for the CY 2015 Medicare Physician Fee Schedule, finalizing the rule for 2015 implementation. CMS will move forward with eliminating the 10- and 90-day global surgery codes and has slightly reduced the reimbursement for the new chronic care management code.

Global Surgery Codes

CMS moved forward with eliminating 10- and 90-day global surgery codes, but will do so in a staged manner. The elimination will begin with the 10-day global services in 2017 and followed by 90-day global services in 2018. These codes include the patient visit on the day of the procedure, the procedure itself, and any complications resulting from the surgery, and all follow-up care during the 10- or 90-day recovery period.

CMS has found that global codes may pay for more follow-up care than is usually furnished to Medicare patients resulting in the 2015 final rule timeline for eliminating 10- and 90-day global payments for all care settings. This will require physicians to bill separately for the day of the surgery (known as a zero-day global payment) and any encounters after that day.

Care Coordinating Codes

The proposed rule set reimbursement for the new chronic care management code at $41.92, but CMS has set the finalized amount at a lower amount of $40.39. Providers are able to bill the new code once per patient every 30 days, if they provide at least 20 minutes of care coordination work during that period. This includes non-face-to-face coordination services such as revision of patient care plans, medication management, and communication among treating practitioners.

CMS has also finalized two key proposals tied to the implementation of this code:

  • Encourage team-based care: The final rule allows physicians to provide only general supervision rather than direct on-site oversight to clinical staff members whose activities can count toward the required 20 minutes of work.
  • Flexibility in use of Electronic Health Records (EHRs): EHRs do not have to be 2014-certified as initially proposed. CMS will allow practitioners to bill for services provided under the new chronic care management codes from a 2013-certified EHR system if they have not upgraded to a 2014-certified system.

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