Summary Medicare Physician Fee Schedule Payments

On Oct. 30, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (PDF, 5.6 MB) that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2016. This year, CMS finalized a number of new policies, including several that are a result of recently enacted legislation.

“This is the first PFS final rule since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).1

The calendar year 2016 PFS final rule is one of several final rules reflecting a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.

A Fact Sheet provided by CMS, discusses the changes to payment policies and payment rates for services furnished under the PFS and other programs.

Summary CMS Outpatient Prospective Payment System and Ambulatory Surgery Center Payments

On Oct. 30, 2015, CMS released the Calendar Year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates final rule with comment period (OPPS/ASC final rule) [CMS-1633-FC]. The Final Rule updates Medicare payment policies and rates for hospital outpatient departments (HOPDs), ASCs, and partial hospitalization services provided by community mental health centers (CMHCs), and refinements to programs that encourage high-quality care in these outpatient settings. OPPS payment amounts vary according to the Ambulatory Payment Classification (APC) group to which a service or procedure is assigned. The final rule also includes important changes to the Two Midnight Rule effective beginning in CY 2016. See the related fact sheet for detailed information.

View complete McKesson Summary of the 2016 PFS, OPPS and ASC Policy Changes for Independent Physicians (PDF, 551 KB).

1 CMS. Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year 2016. Fact Sheet. Oct. 30, 2015.

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About the author

Lisa A. Schroeder, CHC, CPC, CCS-P is Compliance Director of McKesson Business Performance Services