Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid…
Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release;
SUMMARY: This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from
EFFECTIVE DATE: These regulations are effective on
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SUPPLEMENTARY INFORMATION:
Table of Contents
I. Executive Summary and Background
A. Executive Summary
B. Background
II. Provisions of the Final Rule for PFS
A. Determination of Practice Expense Relative Value Units (PE RVUs)
B. Determination of Malpractice Relative Value Units (MRVUs)
C. Medicare Telehealth Services
D. Potentially Misvalued Services Under the Physician Fee Schedule
1. Background
2. Progress in Identifying and Reviewing Potentially Misvalued Codes
3. Validating RVUs of Potentially Misvalued Codes
4. CY 2017 Identification and Review of Potentially Misvalued Services
5. Valuing Services That Include Moderate Sedation as an Inherent Part of Furnishing the Procedure
6. Collecting Data on Resources Used in Furnishing Global Services
E. Improving Payment Accuracy for Primary Care, Care Management Services, and Patient-Centered Services
F. Improving Payment Accuracy for Services: Diabetes Self-Management Training (DSMT)
H. Phase-In of Significant RVU Reductions
I. Geographic Practice Cost Indices (GPCIs)
J. Payment Incentive for the Transition From Traditional X-Ray Imaging to Digital Radiography and Other Imaging Services
K. Procedures Subject to the Multiple Procedure Payment Reduction (MPPR) and the OPPS Cap
L. Valuation of Specific Codes
M. Therapy Caps
III. Other Provisions of the Final Rule for PFS
A. Chronic Care Management (CCM) and
B. FQHC-Specific Market Basket
C. Appropriate Use Criteria for Advanced Diagnostic Imaging Services
D. Reports of Payments or Other Transfers of Value to Covered Recipients: Summary of Public Comments
E. Release of Part C Medicare Advantage Bid Pricing Data and Part C and Part D Medical Loss Ratio (MLR) Data
F. Prohibition on Billing Qualified Medicare Beneficiary Individuals for Medicare Cost-Sharing
G. Recoupment or Offset of Payments to Providers Sharing the Same Taxpayer Identification Number
H.
I. Medicare Advantage Provider Enrollment
J. Expansion of the Diabetes Prevention Program (DPP) Model
K. Medicare Shared Savings Program
L. Value-Based Payment Modifier and Physician Feedback Program
M. Physician Self-Referral Updates
N.
IV. Collection of Information Requirements
V. Regulatory Impact Analysis
Regulations Text
Acronyms
In addition, because of the many organizations and terms to which we refer by acronym in this final rule, we are listing these acronyms and their corresponding terms in alphabetical order below:
A1c Hemoglobin A1c
ACO Accountable care organization
ASC Ambulatory surgical center
ATRA American Taxpayer Relief Act (Pub. L. 112-240)
AWV Annual wellness visit
BBA Balanced Budget Act of 1997 (Pub. L. 105-33)
BBRA [
CAD Coronary artery disease
CAH Critical access hospital
CBSA Core-Based Statistical Area
CCM Chronic care management
CEHRT Certified EHR technology
CF Conversion factor
CG-CAHPS Clinician and Group Consumer Assessment of Healthcare Providers and Systems
CLFS Clinical Laboratory Fee Schedule
CoA Certificate of Accreditation
CoC Certificate of Compliance
CoR Certificate of Registration
CNM Certified nurse-midwife
CP Clinical psychologist
CPC Comprehensive Primary Care
CPT [Physicians] Current Procedural Terminology (CPT codes, descriptions and other data only are copyright 2015 American Medical Association. All rights reserved.)
CQM Clinical quality measure
CSW Clinical social worker
CT Computed tomography
CW Certificate of Waiver
CY Calendar year
--This is a summary of a
Final rule.
CFR Part: "42 CFR Parts 405, 410, 411, 414, 417, 422, 423, 424, 425, and 460"
RIN Number: "RIN 0938-AS81"
Citation: "81 FR 80170"
Document Number: "[CMS-1654-F]"
Federal Register Page Number: "80170"
"Rules and Regulations"
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