Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

No More SGR to Worry About, But How Do You Like MACRA?


For the first time in several years, the Centers for Medicare and Medicaid Services (CMS) issued a final rule updating payment policies under the Medicare Physician Fee Schedule (PFS) without the threat of drastic payment cuts for physicians under the flawed Sustainable Growth Rate. That formula was repealed and replaced by Congress back in April under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Some providers still aren’t happy though. Under the new MACRA, providers were expecting a .5 percent payment increase for 2016. However, that didn’t happen either. Instead, that increase was reduced by a .02 percent RVU “budget neutrality adjustment” and an additional .77 percent because CMS did not meet a certain mandated cost-savings target.

That misvalued code guideline was implemented and revised under the Patient Protection and Affordable Care Act (ACA), the Protecting Access to Medicare Act of 2014 (PAMA), and the Achieving a Better Life Experience Act of 2014 (ABLE). Among those three acts, Congress set a target to adjust down misvalued codes in the fee schedule by 1 percent for 2016 and by .5 percent for 2017 and 2018. However, for 2016, CMS identified changes to achieve only .23 percent in net reductions. That shortfall necessitated the .77 percent reduction to all PFS services.

After all the calculations were made, the 2016 conversion factor came in at $35.8279, .3 percent less than the current 2015 factor of $35.9335.

According to a Medscape Medical News article, though the decrease is small, some providers are still angry that they are receiving a cut at all. “CMS’s inaction will result in an across-the-board cut to physicians in 2016,” said Halee Fischer-Wright, MD, the president and CEO of the Medical Group Management Association (MGMA). “For all the ambitious plans touted by the agency to move Medicare toward a value-based payment system for physicians, its inability to adequately review misvalued codes under current fee-for-service calls into question how CMS will be able to implement far more sophisticated payment models in the future.” Fischer-Wright submitted a statement to Medscape Medical News on behalf of MGMA.

The 2016 Medicare PFS also implemented several other payment guidelines. For a summary of top issues, visit our blog post “2016 Medicare Physician Fee Schedule: 5 Things to Note.” You also can review the CMS Fact Sheet about the 2016 MPFS Final Rule or scan through the entire final rule for yourself.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com. Photo by David Goehring via Flickr used with permission under the Creative Commons License.


Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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