Lucy Zielinski
Lucy Zielinski

On Nov. 1, 2018, the Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule (PFS) final rule was released. It includes payment rate and policy updates for services furnished on or after Jan. 1, 2019, and is scheduled to be published in the Federal Register on Nov. 23.

Here are few key points:

  • For E/M visits, CMS is reducing documentation burdens
  • CMS is postponing the collapse of E/M visit codes/payments until 2021
  • CMS expanded reimbursement for virtual care
  • Work RVUs were established for new codes, including biopsies, sleep studies, chronic care management, and psychological and neuropsychological testing
  • The 2019 payment impacts are included; some of them are:
    • 0 percent for family physicians
    • Increases include 3 percent for clinical psychology, 2 percent for podiatry and vascular surgery, and 1 percent for dermatology
    • Decreases include -5 percent for diagnostic testing facilities and -1 percent PT/OT
  • Under the Quality Payment Program (QPP), the percentage of cost category is increasing to 15 percent
  • Quality measures were updated for inclusion and removal
  • The conversion factor increases from 35.9996 to 36.0391

In addition, the final rule stipulates the following:

  • Eliminates the requirement to document the medical necessity of a home visit in place of an office visit
  • For established patients, when relevant information is already in the medical record, practitioners can focus documentation on what has changed since the last visit, and they don’t need to re-enter the defined list of required elements as long as they have reviewed and updated the previous information as needed
  • Practitioners don’t need to re-enter information on the patient’s chief complaint and history that has already been entered by ancillary staff or the patient
  • Removes the potentially duplicative requirements for notations in medical records that may have previously been included by residents or other members of the medical team for E/M visits furnished by teaching physicians
  • Adds payments for some telemedicine services, including brief communication technology-based service, (e.g., virtual check-in)
  • Removes evaluation of recorded video and/or images submitted by an established patient

Lucy Zielinski is managing partner for Lumina Health Partners.

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