2016 Medicare Fee Schedule and Payment Issues

March 23, 2016
On February 12, 2016, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Program; Reporting and Returning of Overpayments final rule that requires providers and suppliers receiving funds under the Medicare program to report and return overpayments. The rule is intended to to ensure compliance with applicable statutes, promote the furnishing of high quality care, and to protect the Medicare Trust Funds against fraud and improper payments, in addition to provide clarity and consistency in the reporting and returning of self-identified overpayments. Click here to read an overview of the key sections of the final rule.

November 2015
2016 Physician Fee Schedule Update
The results in the final 2016 Physician Fee Schedule rules were mixed for the specialty. We were disappointed to see core A/I codes still included on the potentially misvalued codes list, but very pleased to see few changes to the rules for Quality Clinical Data Registries like the AAAAI QCDR. Analysis of the payment and quality provisions prepared by Hart Health Strategies are available for your review below.

View an analysis of the payment provisions within the 2016 Physician Fee Schedule. Note: member log-in is required.
View an analysis of the quality provisions within the 2016 Physician Fee Schedule. Note: member log-in is required.
Review of AAAAI comments and CMS final action. Note: member log-in is required.

September 2015
The AAAAI submitted a comment letter and signed on in support of two coaltion comment letters in response to the 2016 CMS Proposed Physician Fee Schedule.
 
Of particular concern yet as expected, CPT codes 95004, 94010 and 95165  were included on the list of potentially misvalued codes identified in the proposed fee schedule. In addition to advocating in the comments letter below to remove these from the misvalued codes list, the AAAAI is also working with the ACAAI and the AAO-HNS to address this concern through the RUC.
 
Other issues of signficant concern in the 2016 Physician Fee Schedule addressed by the AAAAI include improving payment accuracy for primary care and care management services, proposed changes to "incident-to" billing requirements, and several areas of quality and public reporting including PQRS, the Value-based Modifier, and Physician Compare.

AAAAI 2016 MPFS Proposed Rule Comments »
Final E & M Coalition PFS comments »
Multispecialty Coalition letter in Response to 2016 MFS Proposed Rule » 

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