CMS Releases final Medicare Physician Fee Schedule for Calendar Year 2014

The Centers for Medicare and Medicaid Services (“CMS”) has released the final version of its 2014 Medicare Physician Fee Schedule (“MPFS”) that determines physician reimbursement for services furnished to Medicare beneficiaries. In addition to adjusting the various formulas that are used to determine payment amounts, the MPFS includes a number of changes to policies and procedures that have the potential to impact physicians and other practitioners paid under the MPFS. CMS plans to publish the official version in the Federal Register on December 10, 2013 and most changes are set to take effect January 1, 2014. The public does, however, have the opportunity to submit comments to CMS for sixty days, with all comments due no later than January 27, 2014.

Currently, under the MPFS, physicians will see a steep decline in reimbursement of over 20% (reflecting a decrease in the Conversion Factor (“CF”) from $34.02 in 2013 to $27.20 in 2014), due in large part to a statutory requirement that limits the amount of annual growth in physician payments. However, whether physicians will see such steep cuts is unclear, as Congress has passed legislation to override this decrease every year since 2003 and Congress is currently considering different proposals to permanently fix the formula to create more certainty for physicians.

Other changes finalized in the 2014 MPFS include:

• Expanding the availability of telehealth by adding new services to the list covered by Medicare as well as by expanding the geographic areas where such services are covered, by adopting the Office of Rural Health Policy’s definition of rural area.
• Updating CMS’s physician quality programs through changes such as allowing individual physicians to submit quality measure data for the Physician Quality Reporting System (“PQRS”) through qualified clinical data registries and aligning PQRS measures with the National Quality Strategy and meaningful use requirements.
• Finalizing a major proposal to begin paying physicians in 2015 for the care-management of patients with more than one chronic condition outside of the traditional face-to-face visit.

Over the next few weeks we will write in more depth about the changes discussed above as well as other changes made by the MPFS. For more information regarding this and related issues, please contact Carey Kalmowitz, Esq., or Adrienne Dresevic, Esq., at (248) 996-8510 or visit the HLP website.