2017 Physician Fee Schedule Updates

Nathan Baugh, Director of Government Affairs

2017 Physician Fee Schedule Updates

On July 6th, the Centers for Medicare and Medicaid Services (CMS) released the 2017 Physician Fee Schedule (PFS) proposed rule. This is one of the major annual rules CMS uses to announce proposed changes to the Medicare program. Most notably for RHCs, this year’s PFS makes numerous changes to the RHC Chronic Care Management (CCM) requirements, including changing the supervision requirement that we believe are welcome and should make it easier to implement CCM services.

Proposed Changes to CCM Requirements for RHCs

The most significant change to the RHC CCM benefit is a change to the supervision requirement from direct to general supervision. The rule states:

To enable RHCs and FQHCs to effectively contract with third parties to furnish aspects of CCM and TCM services, we propose to revise §405.2413(a)(5) and §405.2415(a)(5) to state that services and supplies furnished incident to TCM and CCM services can be furnished under general supervision of a RHC or FQHC practitioner. The proposed exception to the direct supervision requirement would apply only to auxiliary personnel furnishing TCM or CCM incident to services, and would not apply to any other RHC or FQHC services. The proposed revisions for CCM and TCM services and supplies furnished by RHCs and FQHCs are consistent with §410.26(b)(5), which allows CCM and TCM services and supplies to be furnished by clinical staff under general supervision when billed under the PFS.

This proposed change to general supervision would allow CCM services to be furnished by auxiliary personnel without the RHC practitioner in the same building. As the paragraph above alludes to, such a change would allow RHCs to contract with CCM vendors in the same manner as traditional offices.

CMS also proposed a number of other revisions to the CCM benefit designed to reduce administrative burden and improve payment accuracy for CCM services. These proposed requirements include:

Initiating Visit – Changing the requirement that the CCM service be initiated during an AWV, IPPE or comprehensive E/M visit where CCM services were discussed for all patients to only new patients or patients not seen within one year.

Editor’s note: This seemingly would allow for patients that have been seen by the RHC within the past year to have their CCM services be initiated at any visit. We believe this was CMS’s intention with this proposed change but we will be asking for clarification.

24/7 Access to Care – Clarifying that the 24/7 access requirement to care means “access to a RHC practitioner or auxiliary staff with a means to make contact with a RHC practitioner to address urgent health care needs regardless of the time of day or day of week.”

Care Plan Availability – Require timely electronic sharing of care plan information, but not necessarily on a 24/7 basis (as it is now), and allow transmission of the care plan by fax.

Care Transitions – Replacing the requirement that clinical summaries must be formatted to certified EHR technology, with the less burdensome requirement that the RHC must “create, exchange, and transmit continuity of care document(s) in a timely manner with other practitioners and providers.”

To see a full list of the changes CMS is proposing, please see page 183 of the proposed rule and the ensuing chart on page 187.

Supervision Requirement for Transitional Care Management (TCM) services

You may have noticed above that CMS is also proposing to change the supervision requirement for TCM services. As a reminder, TCM services are billable only when furnished within 30 days of hospital, SNF, or mental health center discharge. Within 2 business days, communication must be made by with the patient (may be phone/electronic/direct) and within 14 days a face-to-face visit must occur (7 days for CPT 99496).

CMS is now proposing that the communication-within-two-days-of-discharge part of the TCM benefit may now be performed by auxiliary staff under general supervision. However, the face-to-face visit aspect (within 14 or 7 days) of the benefit would still be retained as is. A TCM service and a CCM service cannot be billed during the same time period for the same patient.

Comments

The NARHC will be commenting in general support of these proposals. If anyone wants to submit their own comments, you may submit comments on www.regulations.gov by September 6, 2016.

If anyone has comments or questions, please feel free to reach out to Bill and myself.

Sincerely,

Nathan Baugh
Director of Government Affairs
(202) 544-1880
Baughn@capitolassociates.com