CMS Releases Proposed 2016 Medicare Physician Fee Schedule

Originally published in the July 8, 2015 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

The Centers for Medicare & Medicaid Services (CMS) released the proposed Medicare physician fee schedule (PFS) rule for 2016. CMS will accept public comments on the rule until Sept. 8, 2015 and intends to issue the final 2016 PFS by Nov. 1, 2015.

The proposed rule:

  • Sets 2016 Medicare payment rates for physician services, including a modest payment increase as a result SGR repeal under the Medicare Access and CHIP Reauthorization Act (MACRA);
  • Establishes criteria for the 2016 performance year for the value-based payment modifier (VBPM), which could result in penalties of 4% in 2018 for high cost/low quality providers;
  • Details criteria for 2016 performance in PQRS to avoid a 2% penalty in 2018;
  • Outlines proposed RVU and payment changes for services CMS considers misvalued;
  • Increases the amount of information about physicians and practices on the Physician Compare website, including information pertaining to quality measure and VBPM performance; and
  • Includes discussion of how the agency may consolidate existing Medicare quality reporting programs in the coming years, as required under MACRA.

In a separate rule, CMS proposed changes to policies and payments regarding hospital outpatient and ambulatory surgical centers.

Visit the Federal Register to view the full proposed 2016 Medicare PFS. CMS has also posted several fact sheets. As always, MGMA will prepare an in-depth analysis of the lengthy proposed 2016 Medicare physician fee schedule for our members and will submit comprehensive comments to the agency. Stay tuned to the MGMA Washington Connection for further updates and contact MGMA government affairs with questions by emailing or calling 202.293.3450, 877.275.6462 toll-free.


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