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PFS Billing-Code Rules 'A Step Forward,' Says AOA

By Christopher Cheney  
   November 07, 2016

New billing-code rules for primary care physicians who treat Medicare patients will increase payments for medical services that are rendered outside of face-to-face office visits.

New Medicare payment rules for physicians set to start on Jan. 1 are a positive development for primary care practices, the American Osteopathic Association says.

Several provisions of the 2017 Physician Fee Schedule final rule are designed to boost payments to primary care practices for non-face-to-face care management, care coordination and cognitive impairment services, according to a Centers for Medicare & Medicaid Services fact sheet released last week.

CMS released details about the 2017 PFS final rule on November 2.

CMS Finalizes 2017 Outpatient-Service Payment Rules

"CMS is finalizing several revisions to the PFS billing code set to more accurately recognize the evolving work of primary care and other cognitive specialties to accommodate the changing needs of the Medicare patient population," the fact sheet says.

"Historically, care management and cognitive work has been 'bundled' into the evaluation and management visit codes used by all specialties. This has meant that payment for these services has been distributed equally among all specialties that report the visit codes, instead of being targeted toward practitioners who manage care and/or primarily provide cognitive services."

Laura Wooster, MPH, interim senior vice president for public policy at the AOA, told HealthLeaders last week that her organization is cautiously optimistic about the billing code changes in the 2017 PFS final rule.

"In terms of what they have done previously, this does feel a little different. We are pretty optimistic that this will be a step forward. The devil will still be in the details though. Some of these codes will be complicated to educate our members on so that they can take full advantage of them," she says.

Allowing primary care physicians to bill for more medical care services that are conducted outside of face-to-face visits with patients is a significant improvement of the PFS, Wooster says.


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Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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