2017 Changes to Billing Codes and Stark Laws Physicians Should Know

Mature doctor and African American businessman looking at documents. There are people around them.

The Centers for Medicare & Medicaid Services (CMS) released its Physician Fee Schedule Final Rule in October detailing the new Quality Payment Program established under the Medicare Access and Chip Reauthorization Act (MACRA). A primary stipulation of the Final Rule increased the physician fee by 0.24 percent as opposed to the 0.5 percent increase originally expected.

Sheridan Chief Quality Officer Gerald A. Maccioli, MD, noted that although the 0.24 percent physician fee increase is seemingly positive, it is not enough to cover the inflationary costs of physician care. “In reality, this increase is a net loss economically,” he said. While disappointing to physicians, this lackluster “increase” belies equally important takeaways from the 2017 Physician Fee Schedule.

The Final Rule includes billing code revisions for primary care and care management, which will more accurately pay primary care practices that utilize multi-specialized care resources in the treatment of patients that have behavioral health conditions.

One condition of the Final Rule particularly pertinent for AMSURG physician partners is the changes to the Stark Laws. “These Stark Laws are in place to prohibit referrals for certain Medicare-paid health services to an entity with which a physician has a financial relationship. Dr. Maccioli said. “The CMS Final Rule expands the number of covered codes and it is imperative for physicians to carefully review them.”

These changes to the Physician Fee Schedule reflect healthcare’s larger transition toward value-based accountable care, as laid out in MACRA, and will go into effect Jan. 1, 2017. “If physicians are asked to co-lead in the volume-to-value revolution, it will succeed; if not, it will fail,” Dr. Maccioli said, underlining the importance of the AMSURG physician partnership model in this shifting healthcare landscape.