CMS Releases CY 2017 Medicare Proposed Payment Regulations

The Centers for Medicare and Medicaid Services (CMS) recently released the CY 2017 proposed Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) rules, which outline changes in the payment in the physician office and hospital outpatient settings respectively.

Under both proposals, we anticipate there will be an increase in reimbursement for hematologists. CMS estimates that under the proposed policies in the MPFS reimbursement for hematology and oncology services will increase by 2 percent. The policy changes under the HOPPS, including estimated spending for pass-through payments, are estimated to result in a 1.6 percent increase for hospitals.

CMS proposes several policies that will improve payment for cognitive services in the MPFS. If finalized, CMS will pay separately for non-face-to-face prolonged evaluation and management (E/M) services. Historically, care management and cognitive work has been “bundled” into the E/M codes. In response to the low utilization of the chronic care management (CCM) services, the agency has proposed to simplify the requirements for this service and add new codes for more complex CCM services. The proposed rule also includes a provision to require health care providers and supplies to be screened and enrolled in Medicare in order to contract with a Medicare Advantage organization.

In the HOPPS proposal, CMS is implementing the site neutral payment provision, which was included in the Bipartisan Budget Act of 2015, requiring that certain items and services furnished by off-campus provider-based departments (PBDs) not to be covered under HOPPS. Instead, these services will be covered under the applicable payment system, which in most cases will be the MPFS, as of January 1, 2017. Changes were also proposed to the Hospital Value Based Purchasing System and the Medicare EHR Incentive Program.

More details on these proposals will be forthcoming.