AMA CPT® Assistant - 2014 Issue 2 (February)
Medicare Physician Payment Changes in 2014 (February 2014)
February 2014 pages 3-6 Medicare Physician Payment Changes in 2014 Conversion Factor for 2014 On November 27, 2013, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule for the 2014 Medicare Physician Fee Schedule (MPFS), which calculated a 20.1% decrease in the Medicare conversion factor if the sustainable growth rate (SGR) became effective on January 1, 2014. On January 2, 2013, the American Taxpayer Relief Act of 2012 was signed, which provided temporary relief from an impending cut to the Medicare conversion factor until December 31, 2013. The Pathway for SGR Reform Act of 2013...
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Article Overview
This article summarizes Medicare physician payment changes for 2014 and explains the broader policy context behind them. It is relevant to physicians, coders, billers, practice managers, and specialty societies that follow the Medicare Physician Fee Schedule, CMS rulemaking, and annual updates affecting payment, reporting, and valuation. The discussion covers conversion factor updates, work and practice expense valuation issues, specialty-specific coding changes, chronic care management, geographic practice cost updates, multiple procedure payment reduction, quality reporting programs, value-based payment, feedback reports, and electronic prescribing.
Why This Topic Matters
The article helps readers understand which CMS payment updates and valuation changes may affect Medicare reimbursement, coding workflows, and compliance planning for 2014 and surrounding years.
Article Sections
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Conversion Factor for 2014
Explains the annual Medicare conversion factor update and the legislative and CMS actions affecting payment policy for 2014. Also places the change in the context of broader physician payment reform efforts.
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Coding Changes and Work Relative Values
Summarizes coding and valuation changes tied to RUC recommendations and CMS implementation for 2014. Includes specialty examples and the general review process used to update work relative values.
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Chronic Care Management
Describes the development of chronic care management policy and its relationship to transitional care management and CPT coding proposals. Covers CMS and specialty society efforts that influenced the emerging service framework.
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Potentially Misvalued Services
Reviews the work of the relativity assessment process used to identify services for reevaluation. Lists the general screening approaches used to flag services for further review.
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PE Relative Values
Discusses practice expense relative value updates, including utilization data and time-based adjustments. Focuses on how CMS applied selected recommendations in 2014.
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PLI Relative Values
Covers limited updates to professional liability insurance relative values and the timing of broader refinements. Notes future CMS review activity in this area.
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MEI
Explains revisions to the Medicare Economic Index and related cost-share adjustments. Summarizes the broader framework used to update the index and associated geographic measures.
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Geographic Practice Cost Index
Describes the scheduled GPCI update cycle and legislative extensions affecting locality adjustments. Also addresses special floors applicable to certain states and regions.
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Multiple Procedure Payment Reduction Modifications
Summarizes Medicare’s multiple procedure payment reduction policy changes for 2014. Includes the types of service categories affected and the related CMS and AMA references.
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Physician Quality Reporting System
Reviews PQRS incentive and penalty timing for 2014 and related reporting options. Explains how the program fits into Medicare quality reporting requirements.
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Value-Based Modifier
Describes the implementation timeline for the value-based modifier and its relationship to performance data and group participation. Covers the general structure of the program and its interaction with quality reporting.
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Physician Feedback Reports
Outlines confidential feedback reports used to preview the impact of future payment adjustments. Discusses the reporting format and planned expansion of availability.
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Electronic Prescribing
Summarizes the final years of electronic prescribing incentive and penalty policies. Includes related program improvements and reporting adjustments.
What You Will Learn
- How Medicare physician payment policy changed for 2014
- What CMS and specialty organizations focused on in the annual fee schedule update
- Which broad service categories were affected by valuation and coding changes
- How quality reporting and value-based payment programs fit into the 2014 Medicare environment
- What major geographic, practice expense, and liability-related updates were discussed
- How electronic prescribing and other reporting programs were structured at the time
Who Should Read This
- Physicians
- Medical coders
- Medical billers
- Practice administrators
- Compliance staff
- Specialty society staff
- Revenue cycle professionals
Codes Discussed
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