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Updates and Tools to Help PA Physicians Understand Proposed 2016 Medicare Fee Schedule and Ease the Transition to ICD-10 on Oct. 1 BY JENNIFER SWINNICH, ASSOCIATE DIRECTOR PRACTICE SUPPORT OF PENNSYLVANIA MEDICAL SOCIETY
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he Centers for Medicare and Medicaid Services (CMS) has been busy with the release of the 2016 Medicare Physician Fee Schedule (MPFS) Proposed Rule and clarification on the joint statement with the American Medical Association (AMA) on ICD-10 implementation. Here are a few highlights.
Advance Care Planning Services The MPFS Proposed Rule aims to enhance support for primary care practices through several different initiatives. This includes allowing payment for Advance Care Planning Services for Medicare beneficiaries. CMS defines advance care planning as a face-to-face meeting with the patient, family members, and/or surrogate for “the explanation and discussion of advance directives such as standard forms (with the completion of such forms, when performed), by the physician or other qualified health professional.” CPT code 99497 is used for the first 30 minutes, and then add-on CPT code 99498 for 30-minute increments thereafter. Although advance care planning was available in the past, it was only covered when included with the Initial Preventive Physical Exam (IPPE), also known as the “Welcome to Medicare” visit. Most beneficiaries were not likely to discuss advance care planning at the time of that visit. This enhancement will allow for greater flexibility for scheduling advance care planning services for both beneficiaries and providers.
Traditional Care Management In recent years, CMS has recognized the need for care management. As a result, CMS developed payment for Transitional Care Management (TCM) for patients recently discharged from inpatient hospitals, and Chronic Care Management (CCM) for patients with multiple chronic conditions. Although these codes were approved in rules from prior years, in the 2016 proposed rule CMS is looking for feedback to relieve some of the administrative burden when billing for care management services. The Pennsylvania Medical Society (PAMED) also offers resources to help providers understand TCM reimbursement at www.pamedsoc.org/TCM and CCM reimbursement at www.pamedsoc.org/CCM.
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