Taking effect on January 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released its final
rule for the 2017 Physician Fee Schedule. The revised regulations focus on reinforcing primary care, behavioral health and diabetes prevention. By providing physicians further incentive to practice quality care, the final rule for the 2017 Physician Fee Schedule will help beneficiaries access the services they need to stay well and live longer, healthier lives.
Background of the Physician fee schedule
Payment for services provided by physicians and other practitioners is made under the Physician Fee Schedule (PFS). These services include visits, surgical procedures, diagnostic tests, therapy services and preventive services. A variety of practitioners and facilities are also paid under the PFS, including nurse practitioners, physician assistants, physical therapists, and radiation therapy centers.
Under the PFS, payments are based on the relative resources used to provide the service. Relative value units are applied to each service for physician work, practice expense, and malpractice. These units become payment rates through the application of a conversion factor, which is updated each year.
Highlights of the CMS Final Rule
The CMS finalized and created several revisions in order to accurately recognize the evolving work of primary care and other behavioral specialties, accommodating the changing needs of Medicare patients. Below are some highlights of the changes the CMS made to the 2017 Physician Fee Schedule.
Better Incentives for Behavioral Health Care Collaboration
Based upon the psychiatric Collaborative Care Model, CMS is establishing new codes that are designed to inspire and reward care that is delivered by a team comprised of both primary care physicians and behavioral health specialists.
New Codes for Complex, Chronic Care Management
A significant update to the Physician Fee Schedule is new and revalued codes for chronic care management, which focuses on new codes covering care activities that take place after the first visit from a patient with multiple chronic conditions. The rule is designed to improve support for primary care practitioners. The CMS rule also now includes separate payments under a new code for assessing and planning care for patients with dementia or other behavioral issues.
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