2016 Medicare Physician Fee Schedule Final Rule Summary
Wednesday, December 16, 2015
The Centers for Medicare & Medicaid Services (CMS) released a final rule on October 30, 2015, which updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2016. This is the first PFS Final Rule since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in April.
This rule includes several changes in the PFS payments and new policies as a result of recently enacted legislation. Moreover, there are changes in the quality reporting initiatives such as the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), the Medicare Electronic Health Record (EHR) Incentive Program, and the Physician Compare website on Medicare.gov.
- The criteria for satisfactory reporting in 2018 remain unchanged from the 2017 PQRS payment adjustment.
- Per MACRA guidelines, a new reporting option will allow group practices to report quality measure data using a Qualified Clinical Data Registry (QCDR).
- The 2018 PQRS payment adjustment will be the final one under this system. Starting in 2019, as required by MACRA, adjustments to payment for quality reporting and other factors will be made under the Merit-Based Incentive Payment System (MIPS).
- There are changes to the Physician Compare website, comprising more public reporting of measures and consumer-friendly benchmark information.
- The quality-tiering methodology (PQRS) will be applied to all qualifying groups and solo practitioners in order to avoid the downward adjustment under the PQRS with the exception that PAs, NPs, CNSs, and CRNAs (both solo practitioners and in groups) will be held harmless from downward adjustments under the quality-tiering methodology in CY 2018.
For a more detailed summary, please go to the SIS Performance Measurement Web page.