Most awaited Regulatory update of July 2016 by Mr Steven Lash.You can leave your comment and ask as many as questions for any further regulatory update.

1. Regulatory Update July 2016 by
Steven Lash

2. Regulatory Update
• MACRA aka Quality Payment Program (QPP)
– MACRA Rules have been analyzed
– A QPP team has been established to create a strategy
and business plan including items for road map
• Waiting on publication of CPC+ Healthcare
Information Technology
• Discussion that QPP will be delayed until July 2017
• CMS reported that only 275,000 Medicare patients
were participating in CCM in 2015

3. 2017 Preliminary Rulemaking for
Physician Fee Schedule (PFS)
• Published July 7, 2017; Final Rules published late October/early
November
• Proposed conversion factor drops very slightly for 2017
– In 2016 it was $35.8043
– It 2017 it will be 35.7751
– $42 becomes $41.94 PMPM.
• CMS proposes to add two new CCM codes
• 99487 – Complex chronic care management services
– Same criteria as 99490
– 60 minutes of clinical staff time
– RVU reimbursement is 60% higher than 99490
• 99489 – Each additional 30 minutes of clinical staff time
– In addition to the CPT code for primary procedure
– Slightly less reimbursement than the base code

4. 2017 Rulemaking- continued
• Waive the face-to-face visit requirement
– Mentioned to CMS in April that it should eliminated as this hinders growth
– If physician does enroll patient during a complex visit then the physician will receive
additional reimbursement
• Clarifying and narrowing the 24/7 access standard
– eliminated the necessity for this beyond current practice
• Clarifying the transitions of care standard
– Loosening the standard so no longer required electronically
• Removing the written consent form requirement
– Will make enrolling quicker and easier
• Eliminated the direct supervision requirement for Rural Health Centers (RHC) and
Federally Qualified Health Centers (FQHC)