iPatientCare Blog - Medicare Physician Fee Schedule for Calendar Year 2019 by CMS

Recent changes to the Medicare Physician Fee Schedule for Calendar Year 2019 by CMS

The centers for Medicare and Medicaid services have included number of changes to the reimbursement policies and quality payment system (QPP). This is called PFS (physician fee schedule) or Final Rule, which is effective from January 1, 2019. CMS estimates that overall impact will be 1% reimbursement cut for Oncology and Radiology specialties in 2019. However, the actual impact on the practices will depend on the mix of services that the practices provide.

What does Final Rule say?

CMS finalized changes that simplify administrative burden while improving payment accuracy for Evaluation and Management visits. Some of the changes will show positive effect by January 1, 2019, and some other changes such as documentation, coding and payment will not be effective until 2021.

For instance, the final rule gives the practitioners a window to review and verify certain information in their patient’s record which was entered by ancillary staff or the patients themselves. This eliminates the requirement to re-record data that has not changed since patients’ prior visit. Also there is addition of code, for the new ‘extended visit’ where the practitioners are required to spend more time with their patients. This extended visit add-on code is used only with E/M office/outpatient level 2 through 4 visits; will only account for additional resources.

New Services added, for which the practice can gain more

There is new addition of services that practitioners/providers can get paid for. One of them is brief communication technology based service and other is the remote evaluation of recorded video and/or images that are submitted. These services improves efficiency and provides convenience for providers and beneficiaries, allowing them to decide whether an office visit or any other medical services is required or not.

Expansion of Telehealth Services has made life easier

The 2019 Physician Fee Schedule Final Rule also expands telehealth services in different areas such as prolonged preventive services. The Substance-Use-Disorder Prevention that promotes treatment and recovery for the whole community is promoted by CMS. It removes the barriers of geographic location and treats patients though telehealth services. Before they were required to seek treatment at a qualified medical treatment center, but after or from July 2019, patients with substance use and mental disorders will be able to receive treatment via telehealth.

More Eligible Providers added in MIPS

CMS is also expanding the Merit-based incentive payment program system (MIPS) by including clinical psychologists, registered dietitians, nutritionists, occupational therapists, audiologists and some other non-practitioner healthcare providers. They are encouraged to check their eligibility and further learn about their MIPS performance category – cost, promoting interoperability, quality, and improvement activities.

Now Small Practices are able to Opt-in too

Sometimes many small practices are not able to participate in MIPS opt-in policy due to low volume threshold. Now the providers are encouraged to exceed at least one, if not all, of the low volume criteria which include providing care for less than or equal to 200 Part B enrolled beneficiaries, billing less than or equal to 90,000 dollars in Part B allowable charges for covered professional service and providing less than, or equal to 200 covered professional services under the Physician Fee Schedule.

This Opt-in provision contributes to earning a positive payback adjustment, without satisfying the previous requirements for participation. This encourages more providers to be eligible in creating a greater pool for sharing of data and information that leads to overall better healthcare environment.

Eight new Quality measures included

There is also addition of eight MIPS quality measures which were finalized by CMS for 2019. Out of these eight, four were based on patients’ reporting of their outcomes. This is part of CMS, larger ‘Meaningful Measures’ through which there is attempt to streamline the documentation and reporting the requirements associated with the programs (MIPS).

What assistance your practice needs?

Under this final rule, there will be continuation of the site-neutral payment policies by CMS. Such as Outpatient Prospective Payment System will be paid 40% for 2019. During such tough transition, iPatientCare will assist you at every step of the process. Through cutting-edge technology solutions like EHR and patient engagement modules and services like CMS certified MIPS registry, our Experts take great pride in working with you and allowing you to serve your patients more effectively and run your practice more efficiently.


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