E/M Coding Alert - 2014 Issue 12
CMS Final Rule: Expect Increase in Medicare Pay in 2015 -- But Brace for Possible Big Changes
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Article Overview
This article summarizes CMS final rule changes for 2015 Medicare payment policy, with emphasis on how the updates may affect emergency medicine, physician practices, and group reporting obligations. It covers fee schedule changes, conversion factor changes, practice expense and malpractice-related updates, global period changes, chronic care management payment, off-campus provider-based department reporting, and several CMS quality programs. The article is useful for physicians, coders, billers, and practice administrators who need a broad view of the Medicare policy landscape for the year and the timing of upcoming reporting and payment changes.
Why This Topic Matters
The article helps readers understand which Medicare payment policies are changing, which programs may affect reimbursement, and which compliance deadlines and reporting updates practices need to watch. It is especially relevant for organizations trying to anticipate revenue impact and prepare for CMS reporting and payment adjustments.
Article Sections
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Here’s the Big Picture
Introduces the overall Medicare payment outlook for the year and discusses specialty-level payment trends in the context of the physician fee schedule final rule.
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Wait for Congress SGR Reprieve
Reviews the pending physician payment update environment and the broader legislative uncertainty affecting Medicare payment levels.
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GPCIs Expire for All But Protected States
Summarizes geographic practice cost index changes and the timing of temporary floor provisions under current law.
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Some Good News on Physician Expense Trends
Discusses expenditure trend information relevant to the broader payment policy discussion and potential long-term reform considerations.
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End in Sight for Global Periods
Covers CMS’s planned transition away from certain global surgical package periods and the timing of those changes.
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Get the Scoop on New Chronic Care Management Payment
Explains the introduction of payment for chronic care management services and the general scope of the service category.
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Watch for New Modifier For Off-Campus Provider-Based Departments
Describes a new reporting requirement affecting off-campus provider-based departments and related claims reporting changes.
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Value Modifier Payment Adjustments
Summarizes updates to the Value Modifier program, including payment-at-risk changes and the affected reporting cycle.
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Quality Tiering Makes A Big Impact
Reviews the quality-tiering component of the Value Modifier and the general direction of payment adjustments for larger groups.
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Expanded Informal Inquiry Process
Notes changes to the process for requesting correction of a perceived Value Modifier determination error.
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PQRS Payment Adjustments Are Only Negative Now
Outlines updated PQRS reporting and payment-adjustment requirements affecting future performance periods and eligible providers.
What You Will Learn
- How CMS framed the 2015 Medicare Physician Fee Schedule update
- Which broad Medicare payment and quality programs were affected by the final rule
- What types of reporting changes practices needed to monitor for future years
- How CMS described changes affecting physician specialty payment trends
- Which CMS timelines were highlighted for policy and reporting transitions
Who Should Read This
- Physicians
- Emergency medicine practices
- Medical coders
- Medical billers
- Practice managers
- Revenue cycle staff
- Compliance staff
- Healthcare consultants
Modifiers Discussed
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