CMS Issues 2019 Physician Fee Schedule, Streamlines Rules

The Centers for Medicare & Medicaid Services (CMS) issued a 2,378-page final rule on calendar year (CY) 2019 physician payment rates on November 1, with numerous new payment policies and quality rules. There are also changes, some up, some down, in payment amounts for various procedures. It’s far too much to provide details in this report, but here are:

1. Something new:

The changes create a Medicare payment for when beneficiaries connect with their doctor virtually using telemedicine to determine whether they need an in-person visit. Medicare will pay providers for brief telemedical patient check-ins and will also pay for evaluation of remote pre-recorded images and/or video. CMS has also expanded the Medicare-covered telehealth services.

“The final 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule…promote access to virtual care,” CMS said. It also changes rules “to ease health information exchange through improved interoperability and updates QPP measures to focus on those that are most meaningful to positive outcomes.”

The rule also streamlines some policies for accountable care organizations (ACOs) ”to reduce burden and encourage better health outcomes.”

CMS says its changes will save physicians 21 million hours of administrative labor over the 10 years beginning in 2021 and will save clinicians $87 million in administrative costs in 2019 and $843 million over the next decade.

2. CY 2019 and beyond changes:

• Eliminating a requirement to document the medical necessity of a home visit in lieu of an office visit.
• For established patients, when relevant information is already in the medical record, practitioners may choose to document what has changed since the last visit, or pertinent items that have not changed, and need not re-record the defined list of required elements if the practitioner reviewed the previous information and updated as needed.
• Clarifying that for evaluation and management (E/M) office/outpatient visits, for new and established patients for visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary.
• Removing potentially duplicative requirements for notations in medical records that may have previously been included in the medical records by residents or other members of the medical team for E/M visits furnished by teaching physicians.

3. CY 2021 and beyond changes:

CMS has issued a completely new set of payment rates and rules for E/M office/outpatient visits, including single rates for visit levels 2-4 for both established and new patients, and allowing flexibility, based on the complexity of medical decision-making or time, instead of the current 1995 or 1997 E/M documentation guidelines.  (See the color chart, created by CMS, for details.)

For more information: https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year

“CMS intends to engage in further discussions with the public to potentially further refine the policies for CY 2021,” the agency said.

E&M Payment Amounts Table – view here