CMS releases physician fee schedule for 2018: 6 things to know

CMS issued its 2018 Medicare Physician Fee Schedule on Thursday, which cuts Medicare payments for services provided by certain provider-owned off-campus hospital departments.

Here are six things to know about 1,250-page final rule.

1. Physician payment rates will increase 0.41 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 0.09 percent adjustment required under the Achieving a Better Life Experience Act of 2014.

2. CMS will reduce current physician fee schedule payment rates for services provided at certain off-campus provider-based departments. 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 Outpatient Prospective Payment System on or after Nov. 2, 2015, are no longer paid for most services under the OPPS. Instead, these facilities began to be paid under the physician fee schedule Jan. 1. For 2018, CMS will pay hospitals 40 percent of the OPPS payment rate for these services. Hospitals are currently paid 50 percent of the OPPS rate. Dedicated emergency department services and off-campus provider-based departments that meet the 21st Century Cures "mid-build" exception are excluded from the payment rate changes.

3. Hospital groups are concerned. America's Essential Hospitals President and CEO Bruce Siegel, MD, said, "We're particularly troubled that these cuts for off-campus, provider-based departments — an additional 20 percent reduction to rates already cut in half by regulation last year — come without an analysis of how they might harm patient care. The cuts run counter to CMS' goal of integrated, coordinated healthcare."

Tom Nickels, executive vice president of the AHA, said, the AHA is concerned CMS' "continued short-sighted policies on the relocation of existing off-campus provider-based clinics will prevent patients and communities from having access to the most up-to-date, high-quality services."

4. CMS will pay for new telehealth services. CMS added the following codes to the list of covered telehealth services for 2018:

  • 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

5. CMS is delaying implementation of the Medicare Appropriate Use Criteria Program for advanced diagnostic imaging until Jan. 1, 2020. The AUC Program would begin with an education and operations testing year in 2020, meaning physicians would start using AUCs and reporting this information on their claims.

6. The final rule establishes 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.

More articles on healthcare finance:

CMS releases final OPPS rule for 2018: 8 things to know
CHS reports $110M net loss, completes 30-hospital divestiture spree
HCA's net income tumbles to $426M in Q3

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