Physician fee schedule rule finalized for 2019

The Centers for Medicare & Medicaid Services (CMS) on Nov. 1 issued the physician fee schedule final rule for calendar year (CY) 2019. In the final rule, CMS modified its proposal to collapse payment rates for level two through five evaluation and management services (E/M) into a single rate for new patients and another for established patients.

In response to public comments, for CY 2019 and CY 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits. Beginning in 2021, Medicare payment rates for E/M and outpatient visit levels two through four will be consolidated into one payment rate, while the payment rate for level five E/M visits will be maintained order to better account for the care and needs of complex patients

The final rule seeks to streamline documentation requirements for E/M visits. Beginning Jan. 1, 2019, providers will be required to document only what has changed since the last visit or pertinent items that have not changed, rather than re-documenting information like family/social history. CMS will end the requirement to re-enter information in the medical record regarding a patient’s chief complaint and history if that information was already entered by ancillary staff or the beneficiary.

Additionally, the final rule removes the restrictions on originating sites for telehealth services treating stroke, kidney disease, mental health and substance abuse.

The rule finalizes updates to the physician Quality Payment Program for the CY 2019 performance year, which is tied to payment in CY 2021. CMS revamps the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS), aligning it more closely with the Promoting Interoperability program for hospitals, among other modifications.

Per the Outpatient Prospective Payment System (OPPS) final rule, CMS will continue to pay off-campus provider-based departments built after Nov. 2, 2015, at 40 percent of the Medicare outpatient payment rate for services they provide and reduce Medicare payments for new Part B drugs from the rate of wholesale acquisition cost (WAC) plus 6 percent to WAC plus 3 percent.