Medicare Compliance & Reimbursement

CMS geared to move forward with value-based payment modifier program.

The introduction of reimbursement for the CPT^® codes for advance care planning (ACP) isn’t the only big change in the 2016 Medicare Physician Fee Schedule proposed rule — you have a plethora of other ground-breaking provisions to look forward to.

For instance, the Centers for Medicare & Medicaid Services (CMS) proposes several other provisions that promote person-centered care, as well as provisions that move the Medicare program from a quantity-based payment system to one that reimburses based on quality of care. First, the proposed rule sets the 2016 Medicare conversion factor at $36.1096.

The proposed rule would implement certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), including the new Merit-based Incentive Payment System (MIPS).

CMS also proposes to improve payment accuracy for primary care and care management services, according to a July 13 analysis by the American Academy of Family Physicians (AAFP). The proposed rule would spur investigation efforts for expanding the Comprehensive Primary Care initiative.

Additionally, CMS proposes to strengthen efforts to develop the value-based payment modifier program that provides enhanced payment to physicians based on the quality and cost of care they furnish to traditional Medicare beneficiaries, AAFP noted.

Finally, the proposed rule updates payment policies and the Physician Quality Reporting System, as well as proposals to implement statutory adjustments to physician payments based on misvalued codes. CMS expects to publish a final rule this fall.