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CMS to begin provider reimbursement for end-of-life care

July 10, 2015
Area(s) of Interest: End of Life Issues Patient Care Payor Issues and Reimbursement Practice Management 


On July 8, the Centers for Medicare & Medicaid Services (CMS) released the first proposed update to the Medicare physician payment schedule since the repeal of the sustainable growth rate (SGR) formula through the Medicare Access and Children’s Health Insurance Plan (CHIP) Reauthorization Act of 2015. One of the biggest changes in the CMS proposal is the assignment of codes to pay providers for end-of-life consultations. In addition the department would make advance care planning “an optional element” of a beneficiary's annual wellness visit.


The American Medical Association (AMA) lauded CMS for the advance care planning proposal. “The proposed Medicare payment rule affirms the need to support conversations between patients and physicians to establish and communicate the patient’s wishes in responding to various medical situations,” said AMA president-elect Andres Gurman, M.D.


As far as general reimbursement of Medicare visits, the document includes a 0.5 percent overall increase in Medicare reimbursement in 2016 for all providers.


The release of the rule triggers a 60-day comment period by stakeholders and the public. CMS is accepting public comments on the proposed rule until September 8, 2015. A final rule will be published this fall.


Click here for a fact sheet on the proposed rule. The full rule will be published soon in the Federal Register.


The California Medical Association is reviewing the proposed rule and will provide additional details and comments in the future.

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