On November 2, 2016, the CY 2017 Medicare Physician Fee Schedule Final Rule was posted. This final rule updated policies affecting the calculation of payment rates, identified potentially misvalued codes, added procedures to the telehealth list, and finalized new policies. Many of these changes are beneficial for ophthalmologists because they increase overall rates for physician reimbursements and the victories are thanks to the many efforts of the American Academy of Ophthalmology (AAO).
The Centers for Medicare & Medicaid Services (CMS) considered public comments and made misvalued code changes that achieve 0.32 CY 2017 Medicare Physician Fee Schedule Final Rule % reduction in net expenditure, slightly below the targeted 0.5%. CMS abandoned its plan to label several ophthalmology codes as misvalued. Ophthalmology had nine codes on the potentially misvalued list. In the current policy, only three codes remain on CMS’ list (65205, 65210 and 67515). The 2017 PFS conversion factor is $35.89, a small increase from the 2016 conversion factor of $35.80.
As the changes relate to retina and glaucoma, the Fee Schedule for 2017 retains CMS’ decision to abandon a flawed methodology used in 2016 to cut glaucoma and retina reimbursements. These decisions were influenced by recommendations from the American Medical Association’s Relative Value-Scale Update Committee for retina and glaucoma codes. CMS acknowledged that reimbursements for trabeculectomy and retina detachment codes set in 2016 did not take into account the intensity or duration of the procedure.
Regarding the postoperative data-collection proposal, CMS drastically scaled back its plan. Under the new plan, only physicians in groups of 10 or more in only nine states (Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island) will be involved. The data-collection effort is voluntary as of January 1, 2017, but will become mandatory beginning July 1, 2017. Participants are required only to report those services that are reported annually by more than 100 practitioners, those that are reported more than 10,000 times or annually exceed $10 million in allowed charges. This cuts down on the number of ophthalmology-specific services that are part of this data collection effort from 250 to 33. CMS will use a single CPT code for reporting the data and not require reporting of preoperative visits that are part of the global package.
CMS will separate individual physicians’ performance from their accountable care organizations. Under this new policy, if the Accountable Care Organization (ACO) fails in its quality reporting, the agency will consider individual PQRS physician reporting, allowing them to avoid potential penalties due to their ACO’s shortcomings.
CMS finalized a shortened reporting period for physicians in the meaningful use program to 90 days. For facilities that meet the agency’s quality reporting requirements, the conversion faction for ambulatory surgical centers is $45.03, whereas those that don’t meet the requirements, their conversion factor will be $44.33.
AAO has worked tirelessly on advocating for changes that will benefit ophthalmologists. Through the changes outlined above, their success is evident.
Click here to see the CY 2017 Medicare Physician Fee Schedule Final Rule