ED Coding & Reimbursement Alert - 2015 Issue 41
Part B Payment: CMS Sets Payment Rates for Advance Care Planning
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Article Overview
This article reviews CMS’s Final Rule for the 2016 Medicare Physician Fee Schedule, with emphasis on newly established payment for advance care planning services, the broader conversion factor update, and selected specialty-specific RVU and reimbursement changes. It is intended for coders, billers, and physician practices that need to understand how the rule affects Medicare Part B payment policy and which service categories were highlighted. The discussion also notes how CMS addressed reporting relationships between advance care planning and other service types, along with the impact on gastroenterology and pathology.
Why This Topic Matters
The article helps practices identify Medicare payment updates that may affect claim generation, expected reimbursement, and service-line planning for the new year.
Article Sections
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Advance Care Planning Payment Under the Final Rule
CMS’s decision to establish separate Medicare payment for advance care planning is discussed, along with the policy context in the physician fee schedule. The section frames the update as part of the 2016 Final Rule.
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Payment Rates and Reporting Context
This section covers the payment methodology discussed in the article and the relationship between the advance care planning services and other categories of physician services. It addresses the broader reporting context presented in the Final Rule.
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Look for Conversion Factor to Drop
The article explains the 2016 conversion factor update and the adjustments that affected the expected physician fee schedule change. It focuses on the overall payment environment rather than a single specialty.
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Gastroenterologists Will See Deeper Pay Cuts
This section summarizes the article’s discussion of payment impacts on gastroenterology services under the 2016 Final Rule. It highlights the specialty-level effect described by CMS and referenced by professional societies.
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Societies React: The American Gastroenterological Association
Professional response to the gastroenterology payment changes is summarized here. The section covers reaction from a specialty society and the broader advocacy response noted in the article.
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Pathologists See Boost
CMS’s described payment changes for pathology are summarized in this section. The article notes that pathology is among the specialties affected differently by the Final Rule.
What You Will Learn
- How CMS’s 2016 physician fee schedule Final Rule affected advance care planning payment
- What broad Medicare payment policy changes were discussed alongside the new service payment
- Which specialty areas were highlighted as experiencing significant payment changes
- How the article frames the impact of the Final Rule on physician practices and Medicare Part B billing
Who Should Read This
- Medical coders
- Medical billers
- Physician practice managers
- Compliance staff
- Gastroenterology practices
- Pathology practices
- Healthcare administrators
Codes Discussed
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