CMS’ final physician payment rule for 2019: 6 things to know

CMS issued its annual update to the Medicare Physician Fee Schedule Nov. 1, which overhauls Medicare billing and expands coverage of telehealth.

Here are six takeaways from the final rule:

1. Physician payment rates. The 2019 physician fee schedule conversion factor is $36.04, which is up from $35.99 this year and reflects a budget-neutrality adjustment required by law.

2. Evaluation and management coding and payment changes. CMS finalized several coding and payment changes aimed at reducing administrative burden and improving payment accuracy for evaluation and management visits. For example, the final rule allows practitioners to review and verify certain information in a patient’s medical record that is entered by ancillary staff or the patient, rather than re-entering the information. For 2021 and beyond, CMS will consolidate the payment rate for E/M visit levels 2 through 4 while maintaining the payment rate from E/M visit level 5, which is the highest-paying code.

3. Site-neutral payment policies. Under the final rule, CMS will continue site-neutral payment policies under Section 603 of the Bipartisan Budget Act. Off-campus facilities built after Nov. 2, 2015, will be paid 40 percent of the Outpatient Prospective Payment System amount for 2019.

4. Telehealth services. CMS will pay physicians for their time when they check in with Medicare beneficiaries via telephone or another telecommunications device. Physicians will also be paid for the time it takes to review a video or image sent by a patient to assess whether a visit is needed.

5. Merit-based Incentive Payment System. For 2019, CMS is adding eight MIPS quality measures, including four based on patients’ reporting of their outcomes. CMS is removing 26 quality measures. After receiving concerns from clinicians who were not eligible to participate in the MIPS program during the first two years, CMS is expanding the program to include physical therapists, occupational therapists, speech pathologists, audiologists, clinical psychologists, and registered dietitians or nutrition professionals. CMS is also finalizing an opt-in policy that allows some clinicians who otherwise would have been excluded under the low-volume threshold the option to participate in MIPS.

6. American Hospital Association weighs in. “Today’s rule will have positive and negative consequences for America’s hospitals and health systems and the patients they serve,” said Ashley Thompson, AHA senior vice president of public policy analysis and development. Specifically, the AHA applauded CMS for expanding physicians’ ability to serve patients through telehealth, but the group expressed disappointment with CMS’ policies regarding site-neutral payments.