CMS Releases Proposed 2015 Physician Fee Schedule and Projects 20.9% SGR Reduction

CMS has issued the Proposed 2015 Physician Fee Schedule and Fact Sheets for specific issues (ASC, ESRD, Home Health, Physician Quality Programs).

SGR Reduction

Although the Protecting Access to Medicare Act Prohibits any SGR reduction for the first 60 days of 2015, i.e., until March 1, 2015, CMS predicts a 20.9% decrease without legislative action.

Value Based Payment Modifier (VBPM)

Increase the risk amount to 2% in 2016 and 4% in 2017, and adds solo practitioners.

Physician Quality Reporting System

The bonus phase ends in 2014 but penalties will continue.

Chronic Care Management (CCM)

CMS proposes a separate payment for CCM services of $41.92 that can be billed no more frequently than once per month.

Global Surgery

CMS is proposing to restructure global surgery payments. We will issue a separate report on this issue.

Telehealth

CMS is proposing to add annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management.

Application of Beneficiary Cost Sharing to Anesthesia Related to Screening Colonoscopies

The Medicare law waives deductible and coinsurance applicable to screening colonoscopy. Increasingly, anesthesia separately provided by an anesthesia professional is becoming the prevalent practice in connection with screening colonoscopies, replacing the previous standard of moderate sedation provided intravenously by the endoscopist, which was bundled into the payment for the screening colonoscopy codes. When provided separately with a screening colonoscopy, Medicare did not waive deductible and coinsurance associated with the separately provided anesthesia. If adopted in the final rule, this revision would have the beneficial result of further reducing beneficiaries’ cost-sharing obligations under Part B. This is because the expanded definition of screening colonoscopy would bring anesthesia furnished in conjunction with the service within the scope of the provision that Medicare Part B pays 100 percent of the Medicare payment amount established under the PFS for certain colorectal cancer screening tests.