Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services’ (CMS) 2019 Medicare Physician Fee Schedule (MPFS), includes changes to both Medicare physician payment and quality reporting program policies.

The Pennsylvania Medical Society’s (PAMED) Practice Support Team has analyzed the final rule and created five Quick Consult fact sheets that provide guidance for physicians and practices on changes that may impact their practice of medicine.

Quality Payment Program – MIPS Year 3
CMS has made changes to the MIPS participation track of the Quality Payment Program for the 2019 performance year. Changes include the addition of clinicians eligible to participate in MIPS, a new option for certain clinicians to opt-in to MIPS participation, an increase to the performance threshold, and updates to the weighting of performance categories.

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Quality Payment Program – Advanced Alternative Payment Models (APMs) Year 3
There are also changes in store for the Advanced APM participation track of the Quality Payment Program for the 2019 performance year. PAMED offers details on topics such as who is eligible for Qualified Advanced APM participant (QP) status, the QP performance period, and MIPS APMs.

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Evaluation and Management (E/M) and Documentation Changes
Effective Jan. 1, 2019, CMS simplified the documentation requirements by eliminating redundancies that do not require changes in coding or payment. As of Jan. 1, 2021, office/outpatient E/M visit levels 2, 3, and 4 will be reduced to a single payment for new patients and for established patients.

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Virtual Care Reimbursement, Part B Drug Payments, and More
For the first time, this rule will allow reimbursement to physicians and other practitioners for virtual care. Medicare will now pay for new communication technology-based services, such as brief check-ins between patients and physicians, and pay separately for evaluation of remote pre-recorded images and/or video.

Other changes include a revised policy for Part B drug payments as well as new modifiers for outpatient physical therapy and occupational therapy services furnished by therapy assistants.

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Appropriate Use Criteria (AUC) Updates
AUC is a consulting and reporting process meant to guide the physician with their treatment decisions, to maximize patient outcomes, while minimizing inappropriate or ineffective utilization of services when ordering advanced imaging for Medicare fee-for-service beneficiaries.

AUC participation remains voluntary in 2019. However, those who consult the AUC through the Clinical Decision Support Mechanism in 2018 and 2019 can receive credit for the Merit-based Incentive Payment system (MIPS) as a high-weighted improvement activity.

On Jan. 1, 2020, the voluntary period concludes, and the program will begin the educational and operations testing period with expectations of full participation.

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