CMS proposes to change Medicare physician fee schedule rule – and much more

The Centers for Medicare & Medicaid Services released yesterday a 1,473 page proposal (CMS-1693-P) that would update physician fee schedule rates by 0.25 percent in calendar year 2019, plus addresses a host of other proposed changes.

The rule proposes paying doctors for virtual visits and paying for their time when they reach out to beneficiaries via telephone or other telecommunications devices to decide whether an office visit or other service is needed.

CMS said the proposal was intended to scale back the amount of information providers must submit, simplifying the billing process and collapsing four separate levels of documentation into just one.

Further analysis of the proposal will be shared at a later time, however a quick summary of what is included is:

  • Potentially Misvalued Codes.
  • Communication Technology-Based Services.
  • Valuation of New, Revised, and Misvalued Codes.
  • Payment Rates under the PFS for Nonexcepted Items and Services Furnished by Nonexcepted Off-Campus Provider-Based Departments of a Hospital.
  • E/M Visits.
  • Therapy Services.
  • Clinical Laboratory Fee Schedule.
  • Ambulance Fee Schedule – Provisions in the Bipartisan Budget Act of 2018.
  • Appropriate Use Criteria for Advanced Diagnostic Imaging Services.
  • Medicaid Promoting Interoperability Program Requirements for Eligible Professionals (EPs).
  • Medicare Shared Savings Program Quality Measures.
  • Physician Self-Referral Law.
  • CY 2019 Updates to the Quality Payment Program.
  • Request for Information on Promoting Interoperability and Electronic Healthcare Information Exchange through Possible Revisions to the CMS Patient Health and Safety Requirements for Hospitals and Other Medicare and Medicaid Participating Providers and Suppliers.
  • Request for Information on Price Transparency: Improving Beneficiary Access to Provider and Supplier Charge Information.

Comments on the proposal are due by Sept. 10.