CMS Releases Final Rules for 2017 Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System

November 15, 2016

The Centers for Medicare & Medicaid Services (CMS) recently released its final rules on the 2017 Medicare Physician Fee Schedule (MPFS) and the 2017 Hospital Outpatient Prospective Payment System (HOPPS). Both rules became available on Nov. 2, and are scheduled to be published in the Federal Register on Nov. 15, 2016.

ASCO is still assessing the impact of the MPFS rule on the oncology community, but an initial review shows that physician payment rates will increase by 0.24 percent in 2017 compared to 2016, after accounting for a 0.5 percent increase required by the Medicare Access and CHIP Reauthorization Act and mandated budget neutrality cuts. It is important to note, however, that the actual impact on individual physician practices will depend on the mix of services provided. The rule also revises billing codes in an attempt to more accurately pay for primary care, care management, and other cognitive specialties.

The HOPPS rule finalized a proposal on electronic health record (EHR) meaningful use for practices. The new rule states that the EHR reporting period for Calendar Year (CY) 2016 is any continuous 90 day period for all returning eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that have previously demonstrated meaningful use. EPs, eligible hospitals, and CAHs that have not previously successfully demonstrated meaningful use in a prior year may avoid the 2018 payment adjustment by attesting by October 1, 2017 to the Modified Stage 2 objectives and measures. CMS also finalized a one-time significant hardship exception from the 2018 payment adjustment for certain EPs who are new participants in the EHR incentive program in 2017 and are transitioning to MIPS in 2017, along with an application process.

ASCO is conducting a detailed analysis of both rules and will submit comments on both to CMS during the open comment period. Stay tuned to ASCO in Action for more information when it becomes available. 

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