Examples of the 2019 Proposed Updates to the Medicare Physician Fee Schedule

On July 12, 2018, CMS published its annual update of the Medicare Physician Fee Schedule.

The proposed rule includes an overhaul of Evaluation and Management services as well as many other changes that will impact outpatient therapy services, off campus provider-based hospital departments, telehealth, Quality Payment Programs and much, much, more.

A Little Background on the Physician Fee Schedule

“Payment is made under the PFS for services furnished by physicians and other practitioners in all sites of service. These services include, but are not limited to, visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services.

In addition to physicians, payment is made under the PFS to a variety of practitioners and entities, including nurse practitioners, physician assistants, and physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities.

Payments are based on the relative resources typically used to furnish the service. Relative Value Units (RVUs) are applied to each service for physician work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute.”

It looks like CMS is proposing a number of coding and payment changes for E/M visits. For example (taken directly from their website):

• “to allow practitioners to choose to document office/outpatient E/M visits using medical decision-making or time instead of applying the current 1995 or 1997 E/M documentation guidelines, or alternatively practitioners could continue using the current framework;
• to expand current options by allowing practitioners to use time as the governing factor in selecting visit level and documenting the E/M visit, regardless of whether counseling or care coordination dominate the visit;
• to expand current options regarding the documentation of history and exam, to allow practitioners to focus their documentation on what has changed since the last visit or on pertinent items that have not changed, rather than re-documenting information, provided they review and update the previous information; and
• to allow practitioners to simply review and verify certain information in the medical record that is entered by ancillary staff or the beneficiary, rather than re-entering it.”

Join us, the usual suspects, CJ Wolf, Charla Prillaman and Stephani Scott, as we walk through what the proposed changes mean for your organization. In this webinar you’ll learn the pertinent CMS Rules, how you can prepare your organization for the proposed changes, a breakdown of why we believe certain changes will/will not take place.