AMDA Comments on 2016 Physician Fee Schedule

September 18, 2015
Policy Snapshot

AMDA submitted comments this week on the Centers for Medicare & Medicaid Services (CMS) Proposed Rule for Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016 and applauded CMS’ efforts to continue to address the unique needs of the post-acute and long-term care (PALTC) population.

AMDA urged CMS to finalize their proposal to provide reimbursement for advance care planning (ACP) services. “ACP is an integral component of providing optimal care to the PALTC population- the majority of whom are living with multiple chronic conditions and/or are facing end of life issues. Published, peer-reviewed research shows that ACP is among the most significant factors leading to better person-centered care, higher patient and family satisfaction, fewer inappropriate hospitalizations, and lower rates of caregiver distress, depression, and lost productivity,” stated AMDA.

AMDA also encouraged CMS to finalize its proposal to amend the definition of primary care services at section §425.50, for purposes of the Shared Saving Program, to exclude services billed under codes 99304 through 99318 when the claim includes the POS 31 (skilled services in skilled nursing facility [SNF]) modifier. “We believe the agency’s recognition that although the same Current Procedural Terminology (CPT) codes are used to describe patient services in skilled nursing facilities (SNFs) (POS 31) and nursing facilities (NFs) (POS 32), physician visits to skilled SNF patients (SNF—POS 31) and to custodial residents of nursing facilities (NF—POS 32), the patient population is unquestionably quite different,” said AMDA in the letter. AMDA also pushed for the proposal to go further by applying the same definition changes to other programs such as the Physician Quality Reporting System (PQRS), the value-based payment modifier (VM) and meaningful use (MU). All of which fail to achieve value-based performance measures that meet the needs of PALTC settings.

AMDA also requested for CMS to clarify the use of the chronic care management code in the nursing facility (NF) (POS 32) setting. CMS issued MLN Matters number SE1516 earlier this year that included a FAQ about SNF billing and how it cannot be billed, but it was still not clear on billing in the nursing facility. AMDA pointed out that, “Providers may use the same CPT codes (99304-99318) for custodial nursing home patients (nursing facility or NF—POS 32) as for skilled patients (skilled nursing facility or SNF—POS 31), and these can be performed in the same facility since almost all nursing homes provide some skilled and some custodial care. While skilled SNF patients’ nursing home stay is generally covered by Medicare, custodial NF patients’ stay is never reimbursed by Medicare. Therefore, it is still possible for overlap to occur with care management activities by facility staff that are included in the associated facility payment.”

CMS is expected to release their final rule later this year.