CMS releases proposed physician payment rule for 2019: 6 things to know

CMS issued its annual update to the Medicare Physician Fee Schedule July 12, which includes a proposal to pay physicians for their time when they check in with Medicare beneficiaries via telephone or other telecommunications devices to decide if an office visit or other service is needed.  

Here are six key takeaways from the proposed rule:

1. Physician payment rates. CMS proposed increasing physician payment rates by 0.25 percent in 2019, as required by the Medicare Access and CHIP Reauthorization Act. After applying the budget-neutrality adjustment required by law, CMS estimated the 2019 physician fee schedule conversion factor is $36.05, up from $35.99 this year.

2. Evaluation and management coding and payment changes. CMS proposed several coding and payment changes aimed at reducing administrative burden and improving payment accuracy for evaluation and management visits. For example, the proposed rule would allow practitioners to review and verify certain information in a patient's medical record that is entered by ancillary staff or the patient, rather than re-entering the information. The agency also proposed implementing a multiple-procedure payment adjustment that would apply when evaluation and management visits are furnished in conjunction with other procedures.

3. No changes to site-neutral payment policies. CMS plans to continue site-neutral payment policies under Section 603 of the Bipartisan Budget Act. Under the proposed rule, off-campus facilities would be paid 40 percent of the Outpatient Prospective Payment System amount for 2019. Section 603 requires, with the exception of dedicated emergency departments, services furnished in off-campus provider-based departments that began billing under the OPPS on or after Nov. 2, 2015, to be paid under another applicable Part B payment system.

4. Telehealth services. In addition to paying physicians for their time when they check in with beneficiaries via telephone or other telecommunications device, CMS also proposed paying physicians for the time it takes to review a video or image sent by a patient to assess whether a visit is needed.

5. American Hospital Association weighs in. "Today's proposed policies from CMS will provide opportunities and challenges for hospitals and health systems and the patients and communities they are proud to serve each day," said AHA Vice President Tom Nickels. Specifically, the AHA applauded CMS for proposing to expand physicians' ability to serve patients through telehealth, but the group expressed disappointment with CMS' policies regarding site-neutral payments.

6. Comments on the proposed rule are due Sept. 10.

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