CMS Finalizes Physician Fee Schedule for 2019

The Centers for Medicare and Medicaid Services (CMS) released its final changes to the Medicare Physician Fee Schedule and the Quality Payment Program for 2019, which include substantial updates to coverage of telehealth services. The finalized rule also revises proposed changes to evaluation and management (E/M) documentation requirements, based on overwhelming negative responses to the initial proposals.

“Today’s rule finalizes dramatic improvements for clinicians and patients and reflects extensive input from the medical community,” said CMS Administrator Seema Verma. “[It] offers immediate relief from onerous requirements that contribute to burnout in the medical profession and detract from patient care.”

For example, the new rule eliminates the requirement to document the medical necessity of home visits, and 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.

CMS estimates that the new rule will save clinicians $87 million in reduced administrative costs in 2019 and $843 million over the next decade.

The agency also plans to continue its controversial site-neutral billing policies, which are designed to encourage fair competition between medical services provided by hospitals and those provided by physicians. The agency also is making changes to the Merit-based Incentive Payment System, expanding the list of eligible clinicians and adjusting which quality measures it uses to rate participating physicians.

CMS will not implement any payment changes until January 1, 2021, which will allow the agency to collect stakeholder input to further refine payment policies.

Source: CMS press release, November 1, 2018; American Society of Hematology Practice Update, November 8, 2018.

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