CMS Releases 2016 Medicare Physician Fee Schedule Proposed Rule

on office.By Bill Bunker, Executive Vice President, SCI Solutions

The Centers of Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) proposed rule on July 8th. Under the proposal, physicians will see a modest 0.5 percent payment increase on January 1st, 2016.

CMS is accepting public comments on the proposed rule until September 8th. They will issue the final rule by November 1st.

Despite the overall increase, specialties will be affected differently. Here’s a sample:

  • Cardiology: The American College of Cardiology reports the proposed changes to be zero percent. However, this estimate could vary widely depending on the mix of cardiology services provided.
  • Gastroenterology: Becker’s Healthcare reports gastroenterologists will receive cuts of five percent. Colonoscopy family procedures could receive cuts up to 19 percent.
  • Radiology: The American College of Radiology reports the proposed changes to be zero percent, while interventional radiology would see an aggregate increase of one percent and radiation oncology a decrease of three percent.
  • Pathology: MedPage Today reports pathologists are the big winners with an eight percent raise.

Whether payments are proposed to increase or decrease for your specialty, reporting and billing requirements are stricter across the board for Medicare and private insurance payers. It is crucial practices, hospitals, and health systems have efficient processes in place to ensure they are paid for the work they do. Whether it’s securing an insurance authorization prior to a patient visit or proving medical necessity through documentation, it is vital your practice has the resources to stay up-to-speed on requirements to successfully receive payments.

What do you think of the proposed ruling? Will it affect your specialty? Do you have the proper processes in place to bill successfully? Share your comments below.

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