First, the bad news – CMS stepped around giving a specific proposed cut to the fee schedule but noted that its most recent estimates suggest you are facing a 24.4% cut to fees next year unless Congress changes the physician payment formula.
 
The agency does propose changes to quality reporting under both the Physician Quality Reporting System (PQRS) and electronic health record (EHR) incentive programs as part of its proposed fee schedule for 2014, released late July 8.
 
Practices and other interested parties can offer comments on the CMS proposals until Sept. 6. Expect a final rule to come out about Nov. 1 and be effective on Jan. 1, the agency says. Look for complete analysis of the 2014 Medicare Physician Fee Schedule in the July 15 issue of Part B News.
In the meantime, here are some highlights:
  • New payable codes for complex chronic care management services – CMS would establish two new G-codes for “separately payable non-face-to-face complex chronic care management services,” including “regular physician development and revision of a plan of care, communication with other treating health professionals and medication management.” One code would be for the initial 90 days, and one for the subsequent 90 days of complex care. Patients must have had an annual wellness visit or initial preventive physical examination that establishes their need for chronic care to be eligible under the proposal. Physicians who wish to bill for it will have to meet several requirements.
  • Telehealth and TCM – CMS proposes to add transitional care management codes 99495 and 99496 to the list of Medicare telehealth services. “We believe that that the interactions between the furnishing practitioner and the beneficiary described by the required face-to-face visit component of the TCM services are sufficiently similar to services currently on the list of Medicare telehealth services,” the rule states.
  • PQRS – CMS wants to increase the number of measures eligible professionals would be required to report for the 2014 PQRS incentive from three to at least nine measures covering at least three of the National Quality Strategy domains. If less than nine measures apply to the eligible professional, the professional would report one to eight measures. CMS also proposes revamping PQRS reporting periods. For example, providers have 12-month period from Jan. 1 to Dec. 31 to report the nine measures, regardless of whether they are reported via claims, registry or qualified clinical data registry. Both registry options must report for at least 50% of eligible patients to get the 2014 incentive and avoid the 2016 penalty. Practices of 25 or more providers could earn incentives in 2014 and avoid the 2016 penalty with the CMS-developed Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient survey and six other PQRS.
  • Misvalued codes – CMS proposes to “adjust” payment rates for more than 200 codes in which Medicare pays more for services in an office than an outpatient hospital department or ambulatory surgical center (ASC). CMS is not proposing new multiple procedure payment reduction (MPPR) policies, though it continues to “look at expanding MPPR based on efficiencies when multiple procedures are furnished together.”
  • Therapy caps revised – Outpatient therapy services received in a critical access hospital will count towards the annual therapy cap, according to one section of the proposed rule. These services will also need to comply with existing exceptions requirements, be subjected to the multiple procedure payment reduction for therapy services and receive a manual review when services for a patient exceed the $3,700 threshold.
  • Incident-to language tightened – In the aftermath of an OIG report that found incident-to services were performed by unqualified personnel, CMS plans to make it very clear that state law controls who may provide services incident-to: “We are also proposing to amend the definition of auxiliary personnel at §410.26(a)(1) to require that the individual performing ‘incident-to’ services meets any applicable requirements to provide the services, including licensure, imposed by the state in which the services are being furnished.”
  • Overpayments – Providers and suppliers can be found “without fault” or not responsible for incurring overpayments and get a waiver after a certain amount of time. CMS proposes giving itself more time – five years instead of three – to go after physicians who owe those overpayments.
  • Investigational device exemption (IDE) rules – CMS is proposing new standards and a centralized review process for both FDA Category A (experimental, safety not established) and Category B (safety established) device clinical trials. Coverage of Category B devices and studies would be determined at the national – no longer at the local – level.
  • Screening test coverage expansions – CMS proposes to no longer require abdominal aortic aneurysm (AAA) screenings to be referred as part of the initial preventive physical exam (IPPE), which would allow a greater number of patients to be screened. Also for fecal occult blood tests, CMS would extend Medicare’s conditions of coverage to allow an attending physician, physician assistant, nurse practitioner or clinical nurse specialist to furnish written orders for the screening test to allow expanded access, particularly in rural areas.
  • Possible payments for chiropractic providers for E/M services - Chiropractors currently are limited to payment on three codes for chiropractic manipulation treatment (98940-98942). Cautioning that “we are not proposing to pay chiropractors for E/M services in CY 2014,” CMS says it will accept comments on the possibility that other CPT codes that can be billed with E/M codes that might fit the statutory requirement and will consider acting on those comments in future rulemaking.