decisionhealth Newsletters, Part B News - 2015 Issue 11 (November)
See how changes to relative value units will affect your payments in 2016
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Article Overview
This article explains how the final 2016 Medicare physician fee schedule may affect physician payments through changes to relative value unit methodology, practice expense and malpractice RVUs, and the treatment of potentially misvalued services. It is relevant to physicians, coders, practice managers, and reimbursement staff who track Medicare payment policy and annual fee schedule changes. The discussion covers CMS policy updates, specialty-specific practice expense issues, code review activity, and the transition process for valuing new or revised services.
Why This Topic Matters
Medicare fee schedule revisions can change payment expectations across specialties and affect how practices monitor valuation updates, review services under reconsideration, and prepare for annual policy shifts.
Article Sections
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Physician payments
Introduces the article’s focus on Medicare physician payment impacts and the 2016 fee schedule context.
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Practice expense (PE) RVUs
Summarizes practice expense methodology updates, specialty data considerations, and related CMS refinements affecting payment calculations.
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Malpractice RVUs
Covers updates to malpractice RVU methodology and the approach CMS uses to refresh specialty mix data.
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Misvalued codes
Describes CMS review activity for potentially misvalued services and broader categories of codes under consideration.
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RVU adjustments for misvalued services
Addresses how CMS applies revised input values when estimating savings tied to misvalued services and related payment adjustments.
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Valuation of specific codes
Explains the transition process for valuing new, revised, and potentially misvalued services under the 2016 fee schedule.
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Refinement panels to stay
Notes CMS’s approach to retaining refinement panels as part of the valuation feedback process for interim RVUs.
What You Will Learn
- How the 2016 Medicare physician fee schedule addresses RVU-related payment changes
- Which broad policy areas CMS updated for practice expense and malpractice valuation
- How CMS is handling potentially misvalued services and service review timing
- How the fee schedule transition affects valuation of new and revised services
Who Should Read This
- Physicians
- Medical coders
- Practice managers
- Revenue cycle staff
- Healthcare reimbursement professionals
Codes Discussed
Code Ranges Discussed
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