The Centers for Medicare & Medicaid Services (CMS) has issued its Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule, which includes a proposal that could improve physician reimbursement for services furnished to Medicare beneficiaries in skilled nursing facilities.
According to CMS, the proposal relates specifically to ‘Updates to Practice Expense (PE) Methodology – Site of Service Payment Differential’. In this section of the proposed rule, CMS notes that it is correcting for an unintended consequence of changes finalized in last year's Physician Fee Schedule. Those changes modified the Practice Expense (PE) methodology used to calculate physician payments and resulted in a significant payment difference for nursing facility visits based solely on whether a resident's stay was covered under the Medicare Part A SNF benefit. CMS explained that after implementing the revised methodology, it received feedback from stakeholders indicating that the policy created an unintended site-of-service payment differential for physician visits furnished in nursing facilities. In response, CMS is proposing to revise the payment methodology so that physician payments for nursing facility visits would no longer differ based solely on a beneficiary's Part A status. If finalized, the proposal would effectively restore payment parity for physician visits to skilled nursing facility residents and eliminate the payment differential that has existed since last year's rule.
For a fact sheet on the CY 2027 Physician Fee Schedule proposed rule, please click here.
Mass Senior Care will keep members updated on this proposed rule as it advances.