Payment Rulings and Small Provider Practices

November 6th, 2017 - Wyn Staheli, Director of Research
Categories:   Reimbursement   MIPS|PQRS|PQRI   Billing  
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Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems:

  1. Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
  2. Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018
  3. HHAs: Payment Changes for 2018
  4. Quality Payment Program Rule for Year 2

Of these four rulings, the physician fee schedule rule and the Quality Payment Program Rule are the most applicable to those in a smaller healthcare office. Please note that these rulings do change some of the information that was included in Chapter 2 and Chapter 6 of Find-A-Code's specialty-specific Reimbursement Guides.

This article only contains a brief overview of some of the key points more relevant to the smaller healthcare practice. To read a more comprehensive analysis of all four rulings, see “Four Final Rules Affecting CMS Payments for 2018”.

Physician Fee Schedule

This final rule includes a new Patients over Paperwork initiative, RVU changes, and much more. When considering fees, always keep in mind that fees are adjusted based on quality program initiatives.

The following are some highlights from the Final Rule:

CLICK HERE to read the Press Release.

CLICK HERE to read the Final Rule.

Quality Payment Program Rule for Year 2

CMS kept some of the transition year policies and made some other changes designed to reduce the burden of provider participation. Please note that there were some changes from the Proposed Rule. Some key points are:

Note: See Chapter 2.4 of Find-A-Code's specialty-specific Reimbursement Guides for more about the Quality Payment Program.

CLICK HERE to read the Final Rule Overview.

CLICK HERE to read the Executive Summary.

CLICK HERE to read the Press Release.

CLICK HERE to read the Final Rule.

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