CHA News Article

CMS Updates CY 2014 PFS, Including Changes for Hospitals

Under current law, physicians and non-physician practitioners (NPP) will see across-the-board reductions in payment rates based on a formula – the sustainable growth rate (SGR) methodology – that was adopted in the Balanced Budget Act of 1997. Without Congressional action, required by the end of the year, physicians will see payments cut in excess of 20 percent for services in 2014.

The Centers for Medicare & Medicaid Services (CMS) has finalized its CY 2014 conversion factor at $27.2006, reflecting a smaller reduction in the conversion factor than the 24.4 percent cut CMS projected in March.

Key provisions in the CY 2014 physician fee schedule impacting hospitals include the following:

  • CMS has adopted its proposed policy to apply the therapy caps to services furnished by critical access hospitals beginning Jan. 1, 2014. At this time, the therapy cap exceptions process and associated manual medical review process for therapy services that exceed a $3,700 threshold are slated to expire on Dec. 31. Congressional action is required to prevent the imposition of a hard cap on Jan. 1, 2014. In the final rule, CMS announced the therapy cap amount for 2014 will be $1,920.
  • CMS modifies its regulations describing the geographic criteria for eligible telehealth-originating sites to include health professional shortage areas located in rural census tracts of urban areas as determined by the Office of Rural Health Policy. This change will avoid mid-year changes to geographic designations that could result in unexpected disruptions to established telehealth-originating sites and avoid the need to make mid-year Medicare telehealth payment policy changes. In addition, CMS updates the list of eligible Medicare telehealth services to include transitional care management services.
  • Medicare will begin making a separate payment for non face-to-face chronic care management services beginning in 2015. Chronic care management services include the development, revision and implementation of a plan of care; communication with the patient, caregivers and other treating health professionals; and medication management. Medicare beneficiaries with multiple chronic conditions who wish to receive these services can choose a physician or other eligible practitioner from a qualified practice to furnish the services over 30-day periods.

The final rule is attached and will be published in the Dec. 10 Federal Register.