New Center for Medicare and Medicaid Services Fee Schedule Improves Primary Care Reimbursement

cmsThe Center for Medicare and Medicaid Services (CMS) released a new, final Medicare fee schedule for 2017. The new fees will pay primary care clinicians for work that was previously not compensated or undercompensated – including patients with chronic illnesses and those with cognitive and behavioral problems.

According to the CMS, the changes will more accurately recognize and reward the cognitive work and care management performed by primary care physicians and other clinicians who do not specialize in procedures. For example, the proposed fee schedule creates new codes to pay for certain evaluation and management (E/M) services that previously were bundled into other payment codes and that were considered undervalued by many primary care physicians.

The new fee schedule includes billing codes for:

  • Comprehensive assessment and care-planning for patients with cognitive impairments such as dementia
  • Chronic-care management that goes beyond routine chores such as talking to patients on the phone about medication issues
  • Collaboration with mental health specialists to treat patients with behavioral problems
  • Prolonged evaluation and management services that occur outside of a patient visit

Another area that will improve in primary care is an expanded  pilot project for preventing diabetes in 2018. Under the Medicare Diabetes Prevention Program, patients at high risk for developing type 2 diabetes can go to a community-based program that promotes exercise, a better diet, and weight loss. Besides preventing diabetes, Medicare hopes to save several thousand dollars a year per beneficiary in healthcare costs.


Medscape News

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