CMS Finalizes 2019 Medicare Physician Fee Schedule: 5 Things to Know

MedicareThe Centers for Medicare and Medicaid Services (CMS) released the highly anticipated 2019 Medicare Physician Fee Schedule (PFS) final rule on Nov. 1. The Pennsylvania Medical Society (PAMED) is now reviewing the 2,378-page final rule, and we will share our analysis of the final rule with members soon.

In the meantime, check out these 5 things you need to know about the 2019 Medicare PFS:

  1. The proposal to collapse payments for Evaluation and Management (E&M) services has been modified and delayed until 2021 – Originally, CMS proposed collapsing payment rates for levels 2 through 5 for new and established patients. CMS finalized modifications to this proposal – Starting in 2021, visit levels 2 through 4 will be collapsed into a single payment rate for new and for established patients. Level 5 E&M visits will remain for use for the most complex patients.
  2. CMS will NOT implement a proposal which would have reduced payments for E&M services and procedures offered on the same day – CMS had suggested reducing reimbursement for the lower-cost service by 50 percent. PAMED and other physician advocacy groups strongly opposed this proposal. CMS confirmed that they elected not to include this provision due to the volume of physician feedback on potential negative impacts to patient care.
  3. Some E&M documentation requirements will be eased as of Jan. 1, 2019 – Noteworthy among the documentation changes is that physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated. Instead, physicians will review notes from the previous visit, and update changes as necessary.
  4. Starting Jan. 1, 2021, there will be new options for documenting E&M level 2 through 5 visits – Physicians and other clinicians will be able to use medical decision-making or time spent with patients instead of applying the current 1995 or 1997 E&M documentation guidelines, or alternatively practitioners could continue using the current framework.
  5. Clinicians will be able to opt in to the Merit-based Incentive Payment System (MIPS) – For the first time, clinicians or groups will be able to opt in to MIPS, one of the two tracks of MACRA’s Quality Payment Program. This option will be available to those who meet or exceed at least one, but not all, of the low-volume threshold criteria.

These CMS fact sheets offer more details:

Look for more information and analysis in PAMED’s weekly Dose email newsletter and on our website at www.pamedsoc.org soon.

Questions? Contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org


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