CMS released the 2016 final rule for physician payment. Here are 10 things for physicians to know.
1. There will be changes to the Physician Compare website, including star ratings in the 2016 fee schedule. "Benchmarks are important to ensuring that the quality data published on Physician Compare are accurately understood," said CMS. The benchmark would be a five-star rating under the final rule.
2. There was a proposal to include a visual indicator on the profile page for group practices and individual providers who received payment bonuses for the Physician Value-Based Payment Modifier, but CMS is not finalizing that proposal.
3. There is a new exception to the physician self-referral law permitting hospitals, federally qualified health centers and rural health clinics to pay physicians for compensating nonphysician practitioners under some conditions.
4. There is a new exception to Stark Law permitting timeshare arrangements for office space, equipment, personnel, items, supplies and other services used.
5. The minimally invasive sacroiliac joint fusion physician reimbursement increased from $577 to $722. The outpatient payment went up 14 percent to $10,538.
6. There were 17 new procedures added to the ASC payable list, including "lumbar spine proces distrac" for CPT 0171T, "remove spine lamina 1 thr" for CPT 63046 and "decompression of the spinal cord thc" for CPT 63055.
7. There will be separate billing codes and rates for two advanced care planning services for Medicare beneficiaries. "Establishing separate payment for advance care planning codes provides beneficiaries and practitioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families," said CMS.
8. CMS is finalizing payment for advance care planning as an optional element of the "Annual Wellness Visit."
9. Physicians are able to receive payment incentives for high-quality, efficient care under the Value-Based Payment Modifier program. Underperformers are subject to payment adjustments.
10. The final rule includes a proposal that would apply the value modifier to nonphysician eligible professional groups including physician assistants and nurse practitioners. This would begin in the 2018 calendar year payment adjustment period.