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CMS Releases Proposed OPPS, Physician Fee Rules

Cheryl Clark, for HealthLeaders Media, July 9, 2013

Proposed physician fee schedule rule
In this 652-page proposed rule governing the 2014 Physician Fee Schedule, CMS proposes to pay separately for complex chronic care management services starting in 2015. 

"Specifically, we proposed to pay for non-face-to-face complex chronic care management services for Medicare beneficiaries who have multiple, significant, chronic conditions (two or more)."  Rather than paying based on face-to-face visits, CMS would use "G-codes" to pay for revision of care plans, communication with other treating professionals, and medication management over 90-day periods.

These code payments would require that beneficiaries have an annual wellness visit, that a single practitioner furnish these services, and that the beneficiary consent to this arrangement over a one-year period.

The agency proposes to modify telehealth rules so that certain regions classified as "health professional shortage areas or HPSAs are able to benefit.

Significant changes are proposed to the GPCI, or geographic practice cost indices that pay physicians in some regions more than in others based on regional differences in costs, such as malpractice insurance policies.

The proposed rule includes provisions to adjust about 200 "misvalued" service codes "where Medicare pays more for services furnished in an office than in an outpatient hospital department or ambulatory surgical center."

The agency's proposal would establish service caps of two per beneficiary for physical therapy and speech language pathology, and another two per beneficiary for occupational therapy services, when a critical access hospital provides those services starting Jan. 1, 2014.

Comments are due until Sept. 6, 2013.  The final rule is expected on or about Nov. 1.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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