CMS 2019 Medicare Fee Schedule Designed to Reduce Administrative Burdens

The Centers for Medicare & Medicaid Services (CMS) has released its 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule, which the agency says will “address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices.”

However, a controversial payment component of the plan will be delayed until 2021, giving stakeholders more time to provide input and give CMS more time to incorporate additional improvements into the policy, the agency noted.

The proposal was first unveiled in July and touted by CMS as including “historic changes,” that will “improve the nation’s healthcare system and help restore the doctor-patient relationship, by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information.” At that time, the agency asked for input from providers, some of which it says has been incorporated into the final rule.

For calendar years 2019 and 2020, CMS said it is implementing several documentation policies to provide immediate burden reduction, while other changes to documentation, coding, and payment would be implemented in calendar year 2021.

These changes include:

  • Eliminate the requirement to document the medical necessity of a home visit in lieu of an office visit.
  • Allow practitioners to review and verify certain information in a patient’s medical record entered by ancillary staff or the patient, instead of having to re-enter it.
  • Remove 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.
  • Practitioners are not required to re-enter in a patient’s medical record information on the chief complaint and history that has already been entered by ancillary staff or the patient.

Beginning in calendar year 2021, payment for E/M office/outpatient visits will be simplified and payment will vary based on attributes that do not require separate, complex documentation.

Specifically for CMS is finalizing the following policies:

  • Consolidate the payment rate for E/M visit levels 2 through 4 while maintaining the payment rate from E/M visit level 5, the highest-paying code.
  • Allow practitioners to document level 2 through 5 visits using medical decision-making  (MDM) or time instead of applying the current 1995 or 1997 E/M documentation guidelines.
  • For levels 2 through 5 visits, CMS will allow for flexibility in how visit levels are documented— specifically a choice to use the current framework, MDM, or time. For E/M office/outpatient level 2 through 4 visits, when using MDM or current framework to document the visit, CMS will also apply a minimum supporting documentation standard associated with level 2 visits.
  • When time is used to document, practitioners will document the medical necessity of the visit and that the billing practitioner personally spent the required amount of time face-to-face with the patient.
  • Implementation of add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of non-procedural specialized medical care, though they would not be restricted by physician specialty. These codes would only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally would not impose new per-visit documentation requirements.
  • Adoption of a new “extended visit” add-on code for use only with E/M office/outpatient level 2 through 4 visits to account for the additional resources required when practitioners need to spend extended time with the patient.

However, CMS said after listening to concerns raised by commenters, it is not finalizing aspects of the propose rule that would have: (1) reduced payment when E/M office/outpatient visits are furnished on the same day as procedures, (2) established separate coding and payment for podiatric E/M visits, or (3) standardized the allocation of practice expense RVUs for the codes that describe these services.

CMS said it plans to engage in further discussions to potentially further refine the policies for calendar year 2021.

Recognizing the important role that telemedicine is playing in today’s healthcare environment, CMS finalized proposals to pay separately for two newly defined physician services:

  • Brief communication technology-based service, e.g. virtual check-in (HCPCS code G2012). This would allow patients to check with their healthcare provider to determine if an office visit or other service is needed.
  • Remote evaluation of recorded video and/or images submitted by an established patient (HCPCS code G2010). This would allow practitioners to be separately paid for reviewing patient-transmitted photo or video information conducted via pre-recorded “store and forward” video or image technology to assess whether a visit is needed.

CMS also is expanding the use of telemedicine for treatment of opioid use disorder and other substance use disorders.

CMS is reducing the level of supervision required for radiologist assistants that many had complained was overly restrictive.

CMS will discontinue the functional status reporting requirements for outpatient therapy services furnished on or after Jan. 1, 2019

CMS did not to finalize several controversial items, including reduced payment for E/M visits furnished on the same day as procedures, separate coding and payment for podiatric E/M visits, and standardized allocation of practice-expense relative value units (RVU) for certain codes.

The changes will save clinicians $87 million in reduced administrative costs in 2019 and $843 million over the next ten years, according to CMS projections.

There is a lot to digest here. If you have any questions or concerns contact us for additional information at 305-358-4500 or send us an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

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