CMS Issues 2018 Physician Fee Schedule Final Rule

Carl J. Pucci in Finance & Reimbursement

CMS has issued the 2018 physician fee schedule (PFS) final rule. The rule includes updates to payment policies and payment rates, scheduled to take effect January 1, 2018. Note:  the rule increases the Medicare Part B therapy cap from $1,980 to $2,010, effective 1/1/18. 

For full details on the final rule, please refer to the AHCA summary, which is linked in the bulletin below:

Late yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for the calendar year (CY) 2018 physician fee schedule (PFS) and final rule with comment period for the quality payment program (QPP). 

The rule includes updates to payment policies, payment rates, and quality provisions for services furnished under the PFS on or after January 1, 2018

The PFS pays for Medicare Part B services furnished by physicians and other practitioners in all sites of service. These services include, but are not limited to, visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. In addition to physicians, payment is made under the PFS to a variety of practitioners and entities, including nurse practitioners, physician assistants, and physical therapists, as well as radiation therapy centers, independent diagnostic testing facilities, and skilled nursing facilities (SNFs).

Payments are based on the relative resources typically used to furnish the service. Relative value units (RVUs) are applied to each service for work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute. 

The PFS rule includes several provisions that impact SNFs, including the following:

  • Overall payment rates
  • Changes in the values of specific services, including outpatient therapy services
  • Therapy caps
  • Medicare telehealth services
  • Medicare shared savings program

To view the full AHCA summary of these provisions, click here

For more information, email Dan Ciolek at dciolek@ahca.org.

NYSHFA CONTACT:

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36