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Finalized Payment Rules for 2016 issued by CMS

The Centers for Medicare & Medicaid Services (CMS) issued final rules that explain how physicians and other health care professionals will be paid for services provided to Medicare beneficiaries in 2016. According to the CMS announcement, key policies finalized in the 2016 payment rules include:

  • Finalizing the Home Health Value-Based Purchasing model â€" designed to improve health outcomes and value by tying home health payments to quality performance. Money and Doctor EquipmentAll Medicare certified home health agencies that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will participate in this model starting January 1, 2016.
  • Finalizing updates to the “Two-Midnight” rule â€" clarifies when inpatient admissions are appropriate for payment under Medicare Part A. This rule focuses on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries.  Finalizing the End-Stage Renal Disease Quality Incentive Program.
  • Beginning the new physician payment system post the Sustainable Growth Rate (SGR) formula and supporting patient and family centered care â€" CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System, required by the legislation.
  • Finalizing provision to empower patients and their families regarding advance care planning â€" CMS is finalizing its proposal that supports patient and family centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers.

Per CMS Acting Administrator Andy Slavitt, “these rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers.”  Mr. Slavitt goes on to say, “We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly.” If you have any questions please send us an email at [email protected] or reach us by phone toll-free at 855-427-0427.

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