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February 2016

  

Important Changes for Physicians from the 2016 Medicare Physician Fee Schedule: Part I (Stark Changes)

  

 
 

  

     

  

 
 
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Sidney Welch

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Amy McCullough

404.253.6058

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On November 16, 2015 the Centers for Medicare and Medicaid Services (CMS) published the final Medicare Physician Fee Schedule (Final MPFS).1 The Final MPFS addresses changes to the physician fee schedule and related policies, reflecting the continued shift away from fee-for-service to a value-based reimbursement system. Except for the changes to the Stark definition of “ownership or investment interest,” which goes into effect January 1, 2017, the provisions in the Final MPFS are effective January 1, 2016. Comments will be accepted on the Final MPFS through December 29, 2015. Summarized below are select highlights from the Stark Related Physician Fee Schedule Changes in the Final MPFS.

In the Final MPFS, in addition to updating the “designated health services” list,2 CMS included important Stark Law changes including: (i) expansion of the recruitment exception; (ii) technical changes including clarification of the “in writing” and signature requirements and extension of the holdover provisions for several exceptions; (iii) clarification of certain definitions and exceptions; and (iv) new timesharing arrangement exception.

Finally, because the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires Secretary of HHS to issue two reports – the APM Report and the Gainsharing Report, CMS solicited comments regarding the impact of the Stark Law on health care delivery and payment reform, including the “volume or value” and “other business generated” standards to assist in determining the need for additional rulemaking or guidance. CMS is in the process of incorporating some of those comments into the required Reports.

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1 80 Fed. Reg. 70886 (November 16, 2015).
2 The updated, comprehensive Code List effective January 1, 2016, is available on the CMS website at http://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/List_of_Codes.html.

 
 

  

     

  

 
         

 

 

 

  

     

  

 
 

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