CMS’ Final Rule Updating Medicare Physician Fee Schedule for 2016

On November 16, the Centers for Medicare & Medicaid Services (CMS) published its final rule for services furnished under the Medicare Physician Fee Schedule (PFS) on or afterJanuary 1, 2016.  Among numerous other things, the final rule contains two categories of noteworthy updates:  one related to the Physician Self-Referral (Stark) regulations, and the other related to the requirements for “incident to” billing.

Updates to the Stark Regulations

CMS’ final rule includes two new exceptions to the Stark law.  The first will permit payments by hospitals, Rural Health Clinics, and Federally Qualified Health Centers to physicians for the purposes of compensating non-physician practitioners (NPPs), such as Nurse Practitioners and Physician Assistants.  The second will permit timeshare arrangements for the use of office space, equipment, personnel, items, supplies, and other services.  Both new exceptions have specific requirements that must be met in order for the exceptions to apply.

The final rule also contains an update related to physician-owned hospitals and a number of clarifications regarding existing Stark exceptions and definitions, including a clarification that expired leases and personal services arrangements may continue indefinitely on the same terms if otherwise Stark-compliant, including complying with Stark’s fair market value (FMV) requirement.

Updates to “Incident To” Billing Requirements

The final rule also revises CMS’ “incident to” billing regulations in two important respects.  First, the incident to regulations will be amended to provide that the physician or other practitioner who bills for the incident to service must also be the physician or other practitioner who directly supervises the auxiliary personnel who provide the incident to services.

Second, the regulations will also be amended to explicitly prohibit auxiliary personnel from providing incident to services if they have been excluded from Medicare, Medicaid, or any other federally funded health care program by the Office of Inspector General (OIG), or if they have had their enrollment revoked for any reason.

These are just several of the various changes/clarifications contained in the final rule.  For any questions, or if we can assist you in connection with CMS billing issues or any other healthcare compliance related issues, please contact us at (404) 262-6505 or