The Medical Group Management Association (MGMA) sent a special alert for the release of the 2015 Medicare physician fee schedule. There are important changes for independent medical practice administrators and MGMA monitors closely and advocates for its membership base. The MGMA announcement explained that the Centers for Medicare & Medicaid Services (CMS) finalized the 2015 Medicare physician fee schedule (PFS) and unless Congress intervenes, current law requires physician fee schedule rates to be reduced by an average of 21.2% on April 1, 2015 due to the sustainable growth rate (SGR) formula.
MGMA summarized the final rule key points:
- Sets the physician and anesthesia fee schedule conversion factors (CFs) for CY 2015. The CY 2015 PFS CF for Jan. 1, 2015 through March 31, 2015 is $35.8013. The CY 2015 PFS CF for April 1, 2015 through Dec. 31, 2015 is $28.2239. The CY 2015 national average anesthesia CF for Jan. 1, 2015 through March 31, 2015 is $22.5550. The CY 2015 national average anesthesia CF for April 1, 2015 through Dec. 31, 2015 is $17.7913.
- Continues implementation of the value-based payment modifier (VBPM) by applying the 2017 VBPM, based on 2015 reporting, to all physicians, regardless of group size, and increases the amount of payment at risk for groups with 10 or more eligible professionals (EPs) to 4%.
- Makes changes to criteria for avoiding a Physician Quality Reporting System (PQRS) penalty in 2017, based on 2015 reporting. To avoid this 2% penalty, EPs will generally have to report nine measures in 2015.
- Finalizes the agency’s proposal to eliminate the use of 10 and 90-day global surgical codes, beginning in 2017.
- Establishes payment beginning in 2015 for chronic care management services, utilizing CPT code 99490, rather than creating a new G-code.
- Increases the amount of information about physicians and practices on the Physician Compare website, including quality measure performance for groups and individuals.
CMS released additional information, including fact sheets, on its website.