CMS Finalizes Physician Fee Schedule for 2019

The Centers for Medicare and Medicaid Services (CMS) has finalized changes to the Medicare Physician Fee Schedule and the Quality Payment Program for 2019, which include new coverage for telehealth services. The changes, which acknowledge the rising use of telehealth services like virtual visits and video or image reviews, are the most substantial updates to Medicare billing practices since 1995.

The new rule also mandates revisions to the evaluation and management codes that are used to distinguish the complexity of care that patients receive. The changes will spare doctors from repeatedly documenting patients’ medical history for each visit, instead highlighting only changes that occurred between visits.

“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.”

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.

Source: Modern Healthcare, November 1, 2018; CMS press release, November 1, 2018.