Hot Off the Presses: The Details on the 2015 Final Rule

Written by Lauren Milligan on November 13, 2014

The 2015 Final Rule is out and there have been quite a few changes. As part of its push to usher all eligible professionals onto the registry-based reporting boat, CMS has ramped up the requirements for satisfactory PQRS reporting—but that’s not all. Now that we’ve got the details, we’ve summed them up for you here.

  • The penalty for eligible professionals who fail to satisfactorily complete PQRS reporting in 2015 is a 2% payment adjustment to be assessed in 2017.
  • The 0.5% incentive is no longer available.
  • The Back Pain Measures Group has been removed.
  • Each eligible professional must report on at least 50% of his or her Medicare Part B FFS patients.
  • The new minimum number of individual measures on which eligible professionals must report is nine (up from three last year)—or as many as are applicable to each provider based on his or her method of reporting—but the number of measures available to rehab therapists remains the same as in 2014.
  • Brand new for next year: if an eligible professional sees at least one Medicare patient in a billed visit during 2015, he or she must report on at least one cross-cutting measure.

GPRO (Registry Only, Available to Clinics with Two or More Eligible Professionals)

Reporting criteria for GPRO have changed for 2015. Your group can now choose from the following options:

  1. Report on at least nine measures across three NQS domains for at least 50% of your Medicare Part B FFS patients.
    Or
  2. Report on six measures across two NQS domains for at least 50% of your Medicare Part B FFS patients, and complete a CAHPS survey. (Please note that this survey is required for groups with 100 or more eligible professionals.)
    Or
  3. Groups of 25 or more eligible professionals can choose to report via the GPRO Web Interface.
    • Your group must report on all measures included in the Web Interface for its first 248 Medicare Part B patients.
    • If your group has fewer than 248 Medicare patients, then you must report on at least one measure for 100% of your Medicare Part B patients.

Value-based Modifier (VM) Program

Based on the comments it received regarding the VM program, CMS has decided to push back the inclusion of nonphysician eligible professionals in this program until 2018 (instead of 2017). CMS agreed with commenters’ opinion that nonphysician eligible professionals—like physical therapists—would benefit from a more gradual phase-in period so they can better prepare for participation in the program.

Therapy Cap

  • The 2015 therapy cap for PT/SLP (combined) and OT is $1,940 (up from $1,920 in 2014).
  • Unless Congress takes action, the $3,700 threshold that triggers the manual medical review process—which allows providers to exceed the cap—will expire on March 31, 2015.

Medicare Physician Fee Schedule

The 2015 Medicare physician fee schedule includes “an additional upward payment adjustment” of 1% for physical therapy services. Unfortunately, this increase may not go into effect. Barring an Act of Congress, CMS is required to apply “a reduction to payment rates for physicians’ services of 21.2 percent…under the SGR formula” from April 1, 2015 through December 31, 2015 (for more details, see page 537 of the Final Rule).

There you have it: more than 1,000 pages boiled down to a few short paragraphs. Now that you’re up to speed, what questions do you have? Leave ’em in the comments section below, and we’ll do our best to get you answers.