decisionhealth Newsletters, Coder Pink Sheets - 2015 Issue 12 (December)
2016 Final physician fee schedule: Medicare adds benefit for advance care planning, clarifies incident-to billing
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Article Overview
This article reviews major provisions in the 2016 Medicare physician fee schedule affecting physician practices, especially orthopedic, primary care, and other Part B providers. It covers the new advance care planning benefit, incident-to billing clarification, therapy cap and exception changes, conversion factor and payment updates, quality reporting changes, global surgery data collection, and selected code valuation reviews. The article is relevant to coders, billers, compliance staff, and practice managers tracking Medicare policy changes.
Why This Topic Matters
The final physician fee schedule can affect reimbursement, billing workflow, compliance, and reporting obligations across multiple specialties. Understanding the policy changes helps practices prepare for Medicare payment updates and documentation/reporting requirements.
Article Sections
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Advance care planning
Overview of the new Medicare-covered service and related billing context. This section also discusses its relationship to broader Medicare visit types and eligible settings.
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Incident-to services clarified
Explanation of Medicare’s clarification of incident-to billing and supervision expectations. It also notes a new safeguard related to personnel eligibility.
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Conversion factor drops; payment fluctuates
Discussion of the 2016 physician conversion factor and its effect on selected common evaluation, management, and surgical services. The section also places the fee schedule in the context of broader Medicare payment changes.
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More provisions in the final rule
Additional policy updates covered in the final rule, including global surgery data collection, therapy cap changes, quality reporting adjustments, valuation review activity, and Stark-related exceptions.
What You Will Learn
- What major policy changes were included in the 2016 Medicare physician fee schedule
- Which broad areas of Medicare billing and reimbursement were affected
- How the rule addresses advance care planning and incident-to services
- What types of payment, therapy, quality reporting, and valuation updates were finalized
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
- Physician practices
- Orthopedic practices
- Medicare reimbursement professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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