Medicare’s final rule – will your practice face pay cuts or pay increases?

CMS recently issued the final rule regarding Medicare, which affects payments to doctors and healthcare providers. 

(To get more stories and important updates regarding the latest rules and regulations CLICK HERE, to have our blog delivered directly to your inbox.)

The rule includes Medicare’s 2015 physician fee schedule, and it revises policies on paying different rates for services, depending on the location of the service.

The final rule allows doctors to collect a fee of $42.60 for patients with two or more chronic conditions, even if doctors are using the 2011 edition EHRs.

Initially, CMS had proposed that only doctors using the 2014 edition-certified software would be able to collect the fee.

But the rule isn’t all good for providers…

While CMS is rewarding care coordination, doctors are worried that administrative burdens will outweigh the benefits of the new payment.

The American Medical Group Association will survey its members in 2015 to see if the requirements for the new chronic care-management codes are too onerous for providers. CMS indicated that it will be evaluating the service as well.

There is also the potential that the rule will cut physician payments by 21.2%, because of Medicare’s sustainable growth-rate payment formula.

It is also important to note that practices participating in the CMS Comprehensive Primary Care Initiative are not eligible for the care-management fee. These practices already receive monthly compensation per-member for similar services.

When does this take place?

Cuts take effect April 1, unless Congress intervenes.

In our next blog post, we will keep you informed of related and timely issues.  To get this important information delivered directly to your mail box, 

Do you need help understanding the final rule, or making sure your practice is compliant with the latest rules and regulations?  We can help. To contact us about the final rule, other pertinent rules and regulations, or your other legal needs:  CLICK HERE.

P.S. If you or your patients are interested in consumer healthcare issues, check out

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