6 Things to Know About the 2017 Fee Schedule Final Rule

November 16, 2016
Ericka L. Adler, JD
Ericka L. Adler, JD

Shareholder at Roetzel & Andress

The 2017 Medicare Physician Fee Schedule (MPFS) Final Rule has been finalized and will take effect Jan. 1, 2017. Here's what you should know.

Physicians should be aware that the 2017 Medicare Physician Fee Schedule (MPFS) Final Rule  ("Final Rule") has been finalized and will take effect Jan. 1, 2017.  Among particular items in the Final Rule which physicians may find interesting, include the following:

1. The MPFS conversion factor has been set at $35.887, which is an increase of about .24 percent from 2016. 

2. CMS has made several changes to reduce the administrative burden of chronic care management in order to encourage greater utilization. For example, there is no longer a requirement for written consent for patient enrollment and beneficiaries are not required to have access 24/7 to the care plan as a condition of payment. 

3. Medicare continues to expand telehealth coverage, with the MPFS addressing end stage renal disease related services for dialysis, advanced care planning services, and critical care consultations furnished via telehealth.  This coverage is all through the use of new Medicare G-codes. 

4. Billing codes have been revised to more accurately pay for primary care, care management, and other cognitive specialties. This will include payments to primary-care practices that use interprofessional care management resources to treat patients with behavioral health conditions.

5. Physicians are likely also interested in changes that have occurred related to the federal physician self-referral prohibition, commonly known as "Stark."  The Final Rule has expanded the codes covered under Stark, which can be found at http://www.cms.gov/medicare/fraud-and-abuse/physicianselfreferral/list_of_codes.htmlwww.cms.gov/medicare/fraud-and-abuse/physicianselfreferral/list_of_codes.html. Physicians must review the list to see if services for which federal patients are self-referred may now be covered under Stark.   If so, this may require a review of the practice's referral relationships, lease arrangements and even the compensation arrangements within the practice.  The new codes appear to be primarily in the areas of physical therapy, occupational therapy, radiology (particularly, mammography and PET), as well as certain preventative screening tests.

6. The Final Rule also refinalizes a  limitation on the types of "per-unit of service" compensation formulas from 2009 that may be used for determining office space and equipment rental charges.  Specifically, CMS has restated its requirement that rental charges for the lease of office space or equipment may not use a formula based on per-unit of service rental charges, to the extent that such charges reflect services provided to patients referred by the lessor to the lessee.  This is not an absolute prohibition on rental charges based on units of service furnished.  Per unit of service rental charges for the rental of office space or equipment are permissible, except where the lessor generates the payment from the lessee for referrals to the lessee for a service to be provided in the rented office space or using rented equipment.