2015-11-16 14:41:17 UTC

2016 Medicare Physician Fee Schedule: Analysis & Practical Information

Nov. 16, 2015

AGA summarizes key provisions to help you better understand the impact on your practice

CMS released the calendar year 2016 Medicare Physician Fee Schedule final rule on Oct. 30, 2015. This annual rule provides physician payment updates and requirements for quality programs.  

AGA, in cooperation with ACG and ASGE, has developed a summary of key provisions to help GI practitioners prepare for the payment and policy changes that take effect Jan. 1, 2016, which include: 

  • Changes to reimbursement for lower GI endoscopy services: Despite receiving comments from hundreds of GI physicians and the GI societies, CMS moved forward with unjustified cuts in colonoscopy payments, some of which exceeded 17 percent.  
  • Reimbursement reductions due to misvalued codes target: CMS finalized a 0.77 percent reduction to all PFS services, as required by statute, because the agency failed to meet the target of 1 percent for net reductions in misvalued codes for CY 2016, as required by law. Only 0.23 percent of the target was achieved. 
  • Incomplete colonoscopy: The fee schedule finalized proposals to establish new values for incomplete colonoscopies, which will be paid at one-half value of a completed procedure of the same code.
  • Physician Quality Reporting System and Value-Based Payment Modifier: Because CY 2016 is the last reporting year for these programs as stand-alone programs, no major changes were made. Starting in CY 2019, adjustments to payment for quality reporting and other factors will be made under the Merit-Based Incentive Payment System and Alternative Payment Models, as required by the Medicare Access and CHIP Reauthorization Act (MACRA).  

Review our payment analysis for GI

Read more about PFS changes in the summary prepared by the GI societies.

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