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Medicare 2015 Payment Rates Announced for Physicians, Outpatient Departments, ASCs    

November 4, 2014


The Centers for Medicare & Medicaid Services (CMS) has finalized its calendar year 2015 payment rates and policies for services provided by physicians, hospital outpatient departments, and ambulatory surgical centers (ASC). The changes go into effect in January, 2015.
 

Medicare is increasing payments for hospital outpatient services by 2.3% and for ambulatory surgical centers by 1.4%. Rates for physician services would be cut significantly under existing law, but Congress will likely again enact legislation that stops the large reduction from going into effect. (This may also open the door for replacement of the existing formula that requires such significant cuts.) Payment for individual Physician Fee Schedule (PFS) services may go up or down depending upon the service involved.
 

Major highlights of the final rules:

 

  • Value-based purchasing for physician services: In 2015, CMS will adjust payments to physicians on the basis of how well they performed on quality metrics in 2013. The adjustments will apply only to larger practices in 2015, but to all physicians by 2017. The maximum payment adjustment in 2015 is 1.5%; in 2017, it will be 4%.
  • Quality reporting for hospital outpatient departments and ASCs: CMS is adjusting some quality measures in both the hospital outpatient and ASC quality reporting programs, and making them more consistent between sites of care.
  • Codes: CMS is adjusting payment codes that it believes are potentially misvalued, including those related to use of digital X-ray, which has replaced analog film. The agency is updating the practice expense inputs for X-ray services to reflect this change.
  • Chronic Care Management: CMS is authorizing a separate payment for non-face-to-face services that physicians provide to Medicare beneficiaries who have multiple, significant chronic conditions.
  • Payment Packaging: In hospital outpatient payment, CMS continues to package payment for ancillary services (such as diagnostic tests that are considered integral to a primary service) into a single payment that covers both the primary service and ancillary services. When they are provided alone, CMS pays for the ancillary services separately.
  • Comprehensive APCs: CMS is creating what it calls comprehensive APCs when a primary service, such as implanting a medical device, accounts for a significant portion of the total costs of an APC . The payment for the comprehensive APC will include payment for the all services and items related to the primary treatment. For 2015 hospital outpatient payment, CMS is adding 25 comprehensive APCs.
  • Shared Savings ACOs: CMS is changing or adjusting many quality measures used for judging performance of ACOs participating in the Medicare Shared Savings programs. CMS is also adjusting its quality scoring by rewarding year-to-year quality improvements for such ACOs.
 
Fact sheets on both proposals are available at the CMS website:
 
 
For more information on Medicare value-based purchasing and accountable care organizations, click here.