Palmetto Posts 2016 Medicare Physician Fee Schedule Files

Palmetto’s 2016 Medicare Part B Physician Fee Schedules (MPFS) are now available in their Medicare Physician Fee Schedule tool. The 2016 Medicare Physician Fee Schedule conversion factor is $35.8279, a slight decrease from the 2015 conversion factor of $35.93. This reduction is a result of the Protecting Access to Medicare Act of 2014 and Achieving a Better Life Experience Act of 2014, which both required CMS to set annual targets for reductions in physician fee schedule spending from adjustments to relative values of misvalued codes. The .5 percent increases included in the Medicare Access and Chip Reauthorization Act (MACRA) all but offset the misvalued code target reductions for 2016.

Additionally, the Centers for Medicare and Medicaid Services (CMS) has sent notifications to physicians who will see reductions in Medicare payments due to penalties resulting from the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier and Meaningful Use programs for 2016. Penalties applied as a result of these programs will be in place for the duration of the calendar year, and will be applied to Medicare paid amounts for covered professional services. The penalties will be accompanied by a reason/remark code specifying the program penalty on the remittance advice. If you feel you are being penalized in error, CMS is accepting requests for “informal reviews” to contest these penalties. PQRS informal review requests must be received by Dec. 11, while Value-Based Payment Modifier informal review requests must be received by Dec. 16. According to CMS, requests must be submitted electronically via the Communication Support Page under the Related Links section of the Physician and Other Health Care Professionals Quality Reporting Portal. See the CMS fact sheet on the informal review request process for more information.

 
 

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