AMA CPT® Assistant - 2015 Issue 2 (February)
Medicare Physician Payment Changes in 2015 (February 2015)
February 2015 pages 3-5 Medicare Physician Payment Changes in 2015 Conversion Factor for 2015 On November 13, 2014, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule for the 2015 Medicare Physician Payment Schedule (MFS). The 2015 Medicare conversion factor is $35.7547. It is important to note, however, that this final conversion factor takes into account the adjustment made to the sustainable growth rate (SGR) as a result of the Protecting Access to Medicare Act of 2014 (PAMA). PAMA continued the 0.5% update to the conversion factor from April 1, 2014 through December 31, 2014...
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Article Overview
This article summarizes major 2015 Medicare physician payment policy updates released by CMS and discussed in the CPT Assistant context. It covers the physician fee schedule final rule, work relative value changes, practice expense migration issues, quality reporting programs, geographic payment adjustments, and other payment policy updates relevant to physician practices, coding professionals, and compliance teams.
Why This Topic Matters
The article helps readers understand broad Medicare payment and reporting changes that can affect physician reimbursement, coding review, practice operations, and year-over-year planning. It is especially useful for professionals tracking CMS rulemaking, CPT valuation updates, and quality program requirements.
Article Sections
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Conversion Factor for 2015
Discusses the 2015 Medicare physician fee schedule final rule and the broader policy context behind the annual conversion factor update.
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Coding Changes and Work Relative Values
Introduces CMS implementation of selected valuation recommendations for physician services and summarizes the scope of the review process.
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Care Management Services
Covers CMS policy changes related to monthly care management services and the related technology and supervision framework.
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Migration from Film to Digital Practice Expense Inputs
Summarizes the transition from film-based to digital practice expense inputs and the broader valuation impact on imaging-related services.
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Timeline for Valuing New, Revised, and Potentially Misvalued Services
Explains how CMS handles valuation timing for new, revised, and potentially misvalued services in the rulemaking cycle.
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Potentially Misvalued Services
Describes CMS and RUC processes for identifying services that warrant additional valuation review and re-evaluation.
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Professional Liability Insurance (PLI) Relative Values and Other Changes
Covers the annual update to malpractice-related relative values and related changes affecting service classification and specialty review.
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Medicare Economic Index (MEI)
Summarizes revisions to the Medicare Economic Index and the associated adjustments to cost shares and indices.
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Geographic Practice Cost Index (GPCI)
Reviews geographic payment adjustments and local wage-based calculations used in the physician fee schedule.
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Global Surgery
Discusses CMS policy direction on global surgical periods and the related review timeline for surgical services.
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Physician Quality Reporting System (PQRS)
Summarizes reporting program updates, participation requirements, and changes affecting physician quality reporting.
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Value-Based Modifier (VBM)
Covers implementation changes to the value-based modifier and how the policy affects physician groups and other models.
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Physician Feedback Reports
Describes CMS feedback reports provided to physicians and the types of performance information included.
What You Will Learn
- How CMS framed the 2015 Medicare physician payment update
- Which broad areas of the physician fee schedule changed for 2015
- What kinds of valuation and practice expense topics were addressed by CMS and RUC
- How quality reporting and value-based payment programs were updated
- What geographic, malpractice, and surgery-related policy areas were highlighted
Who Should Read This
- Physician coders
- Coding managers
- Compliance staff
- Revenue cycle professionals
- Medical practice administrators
- Payer policy analysts
Codes Discussed
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