5 Things to Know about Medicare for 2017

As we wrap up 2016, the Centers for Medicare and Medicaid Services (CMS) has released a variety of information healthcare providers need to know about billing Medicare in 2017. We’ve created a shortlist of the top five things you should know.

Medicare Fee Schedule

In November, CMS released the 2017 Medicare Physician Fee Schedule. For a detailed look at some of the provisions that were part of that final rule, check out our blog post, “CMS Releases Medicare Physician Fee Schedule for Calendar Year 2017.” If you just want a data source of the updated fees for Indiana and Michigan, here’s WPS GHA’s downloadable fee schedules. A zipped file of updated fees for all states is available on the CMS Physician Fee Schedule webpage.

Medicare Part B Premiums

For about 70 percent of Medicare beneficiaries, the 2017 Medicare Part B monthly premiums will increase slightly from $104.90 to $109. The small increase is the result of a low .3 percent cost-of-living adjustment announced by the Social Security Administration, which implements a “hold harmless” provision for Medicare Part B premium increases.

Unfortunately, the remaining 30 percent of beneficiaries—those who do not receive Social Security benefits, who enroll in Part B for the first time in 2017, who are directly billed for their Part B premium, who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies, or who pay an income-related premium—must make up the difference of the “hold harmless” provision, and their standard monthly premium will see a 10 percent increase from $121.90 in 2016 to $134.00 in 2017. Their premiums could have been even higher had HHS Secretary Sylvia Burwell not “exercised her statutory authority to mitigate projected premium increases for these beneficiaries, while continuing to maintain a prudent level of reserves to protect against unexpected costs.”

Approximately 5 percent of Medicare beneficiaries pay increased premiums based on a sliding scale of incomes greater than $85,000 per year. Depending on their income, these beneficiaries might pay as much as $428.60 in monthly premiums in 2017.

These premiums do not apply to Medicare Advantage or prescription drug plans, whose premiums are determined separately.

Part B Deductible

CMS also announced that the annual deductible for all Medicare Part B beneficiaries will be $183 in 2017 (compared to $166 in 2016). This deductible does not apply to Medicare Advantage or prescription drug plans, whose deductibles are determined separately.

Revised Form for Reassignment of Benefits

Physicians and non-physician practitioners must use the revised CMS-855R (Reassignment of Benefits) application beginning January 1, 2017, if they haven’t already begun using it. The revised application has been available on the CMS Forms List since April 2016, and Medicare Administrative Contractors (MACs) will accept both the current and revised versions of the CMS-855R through December 31, 2016.

According to CMS, the revised form made the primary practice location section optional. However, this information is shared with other programs, such as the Physician Compare Initiative, to help beneficiaries identify your practice.

Comment on the New Quality Payment Program

The Medicare Quality Payment Program final rule provides for a user-centric approach for developing the program, and CMS is seeking feedback for future rulemaking. Patients, caregivers, clinicians, healthcare professionals, Congress, and others have been invited to submit comments about how CMS can better achieve the goals of the program. Comments on the topics below will be accepted through 5 p.m. ET on December 19, 2016.

Under the Merit-based Incentive Payment System (MIPS):

Virtual Groups
MIPS Scoring
Non-Patient-Facing
Low-Volume Threshold
Groups
Quality Performance Category]
Advancing Care Information Performance Category

Under the Advanced Alternative Payment Models (APMs):

Other Payer Advanced APMs
Nominal Standards
All-Payer Combination Option

In commenting, please refer to file code CMS-5517-FC. Because of staff and resource limitations, CMS cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of four ways (please choose only one of the ways listed):

Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the “Submit a comment” instructions.
By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-5517-FC, P.O. Box 8013, Baltimore, MD 21244-8013. Please allow sufficient time for mailed comments to be received before the close of the comment period.
By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-5517-FC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
By hand or courier. You may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period. For delivery in Washington, DC: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201. For delivery in Baltimore, MD: Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850. Comments erroneously mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.