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CMS Issues Proposed Rates, Policies for 2014 Physician Pay

July 19, 2013

 

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would update payment policies and rates for services furnished under the Medicare physician fee schedule for 2014.

 

  • CMS proposed paying an additional fee to physicians for managing complex chronic care cases beginning in 2015. Specifically, the agency proposed to pay for non-face-to-face complex chronic care management services for beneficiaries who have two or more significant chronic conditions.
  • CMS proposed to adjust payment rates for more than 200 codes where Medicare pays more for services provided in a physician’s office than it pays in a hospital outpatient department or ambulatory surgical center.
  • The proposal does not include provisions on the update in the physician fee schedule rates for 2014 because these are established by a formula set by law. CMS estimated in March, 2013, that the rates would drop by 24.4 percent, but Congress has taken action in prior years to avert such a large reduction.
  • CMS proposed changes to several of its quality reporting initiatives that are associated with physician payment, including the Physician Quality Reporting System and the Medicare Electronic Health Record Incentive program. It also outlined details of the value-based payment system that, starting in 2015, will provide differential payment to physicians based upon the quality of care they provide compared to the cost of care.
  • CMS proposed modifying its regulations broadening eligible telehealth originating sites to include areas within urban settings that have shortages of health professionals. Also, CMS proposed adding transitional care management services to the list of eligible Medicare telehealth services.

 

Comments are due on the proposal by September 6, 2013.  

 

View CMS press release on proposed rule

View CMS press release on proposed changes in physician quality reporting

View the proposed rule