CMS Releases Final 2017 Physician Fee Schedule and Hospital Outpatient Rules

The Centers for Medicare and Medicaid Services (CMS) released final regulations for the 2017 Physician Fee Schedule (PFS) on Nov. 2. This followed the 2017 Hospital Outpatient Prospective Payment System (OPPS) rule release on Nov. 1. These rules solidify Medicare payment and quality provisions for physicians and hospitals in 2017. Under the PFS rule, physicians will see a 0.18 percent conversion factor payment decrease on Jan. 1, 2017. CMS estimates that the physician rule will maintain payment to cardiologists at roughly the same level from 2016 to 2017. This estimate is based on the entirety of payments to cardiologists and can vary widely depending on the mix of services provided in a practice. Under the OPPS rule, hospitals will see a 1.7 percent payment increase next year.

Of note in the PFS rule, CMS finalized additional details for both implementation of the appropriate use criteria (AUC) requirement for advanced imaging services (i.e., SPECT MPI, CT and MR) which will begin no earlier than Jan. 1, 2018, and a 2017 program to collect data on services provided within a surgical global period.

The OPPS rule finalized implementation of the 90-day Electronic Health Record Incentive Program reporting period for 2016 for all eligible professionals, eligible hospitals and critical access hospitals. The reporting period can be any continuous 90-day period between Jan. 1, 2016, and Dec. 31, 2016. The ACC was instrumental in getting a bipartisan, bicameral bill introduced to raise the profile of this issue and signal the need for CMS to take action.

Many other topics are addressed in this rulemaking cycle. Review CMS’ PFS Fact Sheet and OPPS Fact Sheet for details. ACC Advocacy staff are reviewing the rules and will provide additional information in the coming days. Stay tuned to and the ACC Advocate newsletter.

Clinical Topics: Noninvasive Imaging, Computed Tomography, Nuclear Imaging

Keywords: Centers for Medicare and Medicaid Services (U.S.), Electronic Health Records, Fee Schedules, Medicaid, Medicare, Outpatients, Patient Discharge, Prospective Payment System, Tomography, Emission-Computed, Single-Photon, Tomography, X-Ray Computed

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