Published November 1, 2018, the rule updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
Physician payment rates are relatively flat with a 5-cent bump, year-over-year (YOY), but doctors will spend less time during visits entering duplicative information in the patient record and documenting certain visit levels. The Centers for Medicare and Medicaid (CMS) said it believes the new rules will save providers $87 million in reduced administrative costs in 2019 and allow practitioners greater flexibility to exercise clinical judgment in documentation.
The agency also consolidated the payment rate for evaluation and management (E/M) visits levels 2 through 4 and maintains the payment rate for level 5 – the highest rate paid for complex care for the sickest patients. It was a modest approach to the overhaul of E/M codes, expect more structural changes and code consolidation in 2021.
President of the American College of Physicians Ana María López responded to the E/M changes,
While we are encouraged that CMS has recognized the principle that more complex, cognitive care should be reimbursed at a higher level by paying more for level 5, we have reservations about paying level 4 visits, the second most complex visits, at the same amount as levels 2 and 3 visits. We look forward to working with CMS on developing, piloting, and evaluating approaches that recognize the value of complex, cognitive care.
In the final rule CMS made significant changes to the Merit-based Incentive Payment System (MIPS), adjusting its quality methodology in year 3 of the Quality Payment Program (QPP) and opening up the program to more participants including physical and occupational therapists, speech pathologists and clinical psychologists, among others, but not skilled nursing facilities (SNFs).
In an article in McKnight’s Long-Term Care News, Cynthia Morton, executive VP of the National Association for the Support of Long Term Care was critical of the decision saying excluding SNFs makes no sense because it would keep the facilities from receiving a Part B payment update each year. Read her comments in McKnights.
Under the Medicare Shared Savings Program (MSSP) newest rules, ACOs with participation agreements that expire on December 31, 2018 have the opportunity to elect a voluntary 6-month extension of their current agreement period. The new rules are also designed to support coordination of care across settings and strengthen beneficiary engagement as well as provide relief for ACOs impacted by extreme and uncontrollable circumstance in performance year 2018 and subsequent years. Finally, the new rule promotes interoperable electronic health record technology among ACO providers/suppliers.
CMS is also finalizing its proposals to pay separately for two newly defined physicians’ services furnished using telehealth:
- Brief communication technology-based service, e.g. virtual check-in (HCPCS code G2012) and
- Remote evaluation of recorded video and/or images submitted by an established patient (HCPCS code G2010)
The agency also finalized policies to pay separately for new coding describing chronic care remote physiologic monitoring and interprofessional internet consultation.
Finally, the CMS rule will cut Medicare Part B drug payment, altering the reimbursement formula for physician from wholesale acquisition cost plus 6 percent to 3 percent.
Read what the new E.M changes mean to providers in HealthLeaders
Learn more about all the changes from Medpage Today