Nov 30 , 2015

CMS Finalizes Medicare Payment Rules for 2016

CMS (Centers for Medicare & Medicaid Services) has finalized rules on how the agency will pay beneficiaries for services provided by physicians and health care professionals in 2016. This reflects CMS’s commitment to value, quality and patient centered care. The payment rules and physician fee schedules are finalized for Hospital Outpatient Prospective Payment System, End-Stage Renal Disease Prospective Payment System and Home Health Prospective Payment System.

“CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers,” said CMS Acting Administrator Andy Slavitt. “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.”

Significant payment rules finalized for the 2016 are:

1. Finalizing the Home Health Value-Based Purchasing model.

This model is designed to enhance health outcomes and value and it is authorized under the Affordable Care Act. This model attaches quality performance to home health payments. All home health agencies certified by Medicare and providing services in Maryland, Massachusetts, Florida, North Carolina, Arizona, Washington, Nebraska, Iowa and Tennessee can participate in this model from January 1, 2016. In comparison to the proposed rule, the upper limit for payment adjust in the first year is decreased from 5% to 3%. The adjustment is a part of the final rule of the Home Health Prospective Payment System.

2. The updated “Two-Midnight” rule.

The updated rules indicate appropriate steps for payment under Medicare Part A when a patient is admitted. This is a part of CMS long term goal that emphasizes the significance of a physician’s medical judgement in fulfilling the requirements of Medicare beneficiaries by giving clear guidance and a detailed collaborative step to educate and enforce all involved. This final update was as a part of the Hospital Outpatient Prospective Payment System.

3. Final Update on End-Stage Renal Disease Quality Incentive Program

The final rule for End-Stage Renal Disease will give payment incentives to facilities that offer dialysis to   enhance the quality of dialysis care. In the case of facilities that do not gain a minimum total performance score with regard to quality measures like patient experience, anemia management, infections and safety is likely to receive lesser payment rates.

4. Starting the new Physician Payment System after the formulation of the SGR (Sustainable Growth Rate) and aiding the patient-and-family-centered care.

This rule is the first update for Physician Fee Schedule after the repeal of the Sustainable Growth Rate formula by MACRA (Medicare Access and CHIP Re-authorization Act) of 2015. The rule marks the beginning of the implementation of CMS’s new payment method for practitioners and physicians as required by the legislation for Merit-Based Incentive Payment System.

5. Final rule to empower families and patients with advance care planning.

Standing with the recommendations from bipartisan members of the Congress and a number of stakeholders, CMS has finalized the proposal to support family and patient centered care for seniors and other Medicare beneficiaries by allowing them to discuss and plan advanced care with their respective medical providers.


Share this