Medicare Part B Rates for 2014
Introduction
On Nov. 27 the Centers for Medicare and Medicaid Services (CMS) released the final rule for the Medicare Physician Fee Schedule (MPFS) for CY 2014. The MPFS determines the Part B rates paid to physicians, skilled nursing facilities, home care agencies, and other providers billing for ancillary services under Medicare. We are currently in the process of reviewing the final rule and will provide members with a complete analysis. A press release/fact sheet from CMS is also available by clicking here. The complete rule entitled, Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule & Other Revisions to Part B for CY 2014, is not due to be published until Dec. 10, however, an advance PDF copy of is now available.
Highlights of the CY 2014 MPFS
Ongoing Issue with the Sustainable Growth Rate (SGR): Since 2002, we have been dealing with the SGR calculation calling for reductions in the overall MPFS conversion factor (CF). The CF in turn is used to determine changes in the rates from year to year. For 2014, the calculation calls for a 20.1 percent reduction in the CF, which translates into a commensurate average reduction in the rates for next year. As in years past, it is now up to Congress to act to eliminate the cut. Prevailing upon Congress to act is a critical focus of our Washington advocacy efforts. In years past, we have been successful in securing the necessary Congressional overrides thus allowing for rate freezes or minor increases in the face of the SGR problem. Experience tells us that Congressional action is often delayed until after the start of the new year, and for now the final rule is calling for implementation of the rate reduction. Providers should take a wait and see approach to this issue.
Separate Payment for Chronic Care Management: The final rule acknowledges the value and importance of good primary care and chronic care management for beneficiaries with two or more chronic care conditions. Beginning in 2015, CMS will begin making payments for the management of services needed while an individual is transitioning from an institutional to a community setting and for non-face-to-face encounters. Future rule making will determine the practice standards to support the new payment structure.
Telehealth Services: CMS is implementing changes that will allow for more providers in Health Professional Shortage Areas and rural census tracts in urban areas to qualify as originating sites for telehealth services. The goal is to expand the availability of telehealth to rural areas that may be currently underserved.
Application of Therapy Caps to Critical Access Hospitals (CAHs): CMS is finalizing their plans to apply the therapy caps and related policies to outpatient therapy services furnished by CAHs beginning on Jan. 1, 2014. Heretofore, the therapy caps had not been applied to CAHs.
Conclusion
As noted above, we are currently in the process of analyzing the final rule and will provide members with more details and the Medicare Part B rates for the most common therapy codes. Please contact me with any questions at: pcucinelli@leadingageny.org or call 518-867-8827.