On July 8, 2013, CMS released the CY 2014 Medicare Physician Fee Schedule proposed rule. The proposed rule is scheduled to be published in the Federal Register on July 19, 2013. The proposed rule would update current payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule on or after January 1, 2014. CMS released a fact sheet summarizing its proposed changes to certain Physician Fee Schedule payment policies and payment rates. The fact sheet is available by clicking here.

CMS proposes changes to the following policies, among others:

  • Primary Care and Complex Chronic Care Management
    • “[CMS] propose[s] to pay for non-face-to-face complex chronic care management services for Medicare beneficiaries who have multiple, significant chronic conditions (two or more) . . . The proposed rule indicates that CMS intends to establish practice standards necessary to support payment for furnishing complex care coordination management services. Potential standards include access at the time of service to Electronic Health Records (EHR) that meet the HHS certification criteria and written protocols for many aspects of care management implementation, such as specific steps for monitoring medical and functional patient needs.”
  • Telehealth Services
    • CMS proposes “to modify its regulations describing eligible telehealth originating sites to include health professional shortage areas (HPSAs) located in rural census tracts of urban areas as determined by the Office of Rural Health Policy.”
  • Medicare Economic Index (MEI)
    • CMS proposes “revisions to the calculation of the MEI, which is the price index used to update physician payments for inflation.”
  • Application of Therapy Caps to Critical Access Hospitals
    • “The law applies two per beneficiary limits to outpatient therapy services—one for physical therapy and speech-language pathology services and another for occupational therapy services. Before the American Taxpayers Relief Act passed earlier this year, the caps did not previously apply in Critical Access Hospitals (CAH). [CMS] propose[s] to apply the therapy cap limitations and related policies to outpatient therapy services furnished in a CAH beginning on January 1, 2014 to conform Medicare’s regulations to current law.”

The proposed rule also includes several proposed revisions to the following CMS quality reporting initiatives:

  • The Physician Quality Reporting System (PQRS)
  • The Medicare Electronic Health Record (EHR) Incentive program
  • The Physician Compare Website

Additionally, the proposed rule includes proposals for the implementation of the value-based payment modifier (Value Modifier). A CMS fact sheet summarizing the proposed changes to these quality reporting programs and the implementation of the Value Modifier is available by clicking here.

Comments must be received no later than sixty days after the proposed rule is published in the Federal Register. As noted, the proposed rule is anticipated to be published in the Federal Register on July 19, 2013.

To access the proposed rule, click here.