5 proposed changes to the Medicare Physician Fee Schedule in 2018

CMS issued its update to the 2018 Medicare Physician Fee Schedule on Thursday, which includes a proposal to cut Medicare payments by half for services provided by certain provider-owned, off-campus hospital departments.

Here are the five most important changes to note.

1. Physician payment rates will increase by 0.31 percent in 2018 compared to this year. CMS arrived at this increase after accounting for a 0.5 percent increase required by the Medicare Access and CHIP Reauthorization Act and a negative 0.19 percent adjustment required under the Achieving a Better Life Experience Act of 2014.

2. For 2018, CMS is proposing to reduce current physician fee schedule payment rates for services provided at certain off-campus provider-based departments by half. Last year, CMS implemented Section 603 of the Bipartisan Budget Act of 2015. Under this section, certain off-campus provider-based departments that began billing under the OPPS on or after Nov. 2, 2015, are no longer paid for most services under the OPPS. Instead, these facilities began being paid under the physician fee schedule Jan. 1. For 2018, CMS is proposing to pay hospitals 25 percent of the OPPS payment rate for these services. Hospitals are currently paid 50 percent of the OPPS rate.

Hospital groups are concerned. America's Essential Hospitals President and CEO Bruce Siegel, MD, said, "CMS' proposal to pay new, off-campus PBDs only 25 percent of the OPPS rate will result in an unsustainable payment rate that will further reduce access for people in chronically underserved communities — healthcare deserts — and the hospitals on which they rely. Hospitals that otherwise would seek to enhance access by establishing clinics in healthcare deserts will not do so if they determine this damaging payment policy makes new outpatient centers economically unsustainable."

Tom Nickels, executive vice president of the AHA, said the proposal "is yet another blow to access to care for patients, including many vulnerable communities without other sources of healthcare."

3. CMS is proposing to pay for new telehealth services. Under the proposed rule, CMS would add the following codes to the list of telehealth services:

  • HCPCS code G0296: Visit to determine low dose computed tomography eligibility
  • CPT code 90785: Interactive complexity
  • CPT codes 96160 and 96161: Health risk assessment
  • HCPCS code G0506: Care planning for chronic care management
  • CPT codes 90839 and 90840: Psychotherapy for crisis

4. The rule would establish payment to rural health clinics and federally qualified health clinics for regular and complex chronic care management services, general behavioral health integration services and psychiatric collaborative care models. To receive payment for these services, rural health clinics and federally qualified health clinics would use two new billing codes.

5. CMS is proposing to implement the Medicare Appropriate Use Criteria Program for advanced diagnostic imaging. The AUC Program would begin with an education and operations testing year in 2019, meaning physicians would start using AUCs and reporting this information on their claims. 

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