How do the proposed changes in 2019 cms physician fee schedule and quality payment program affect radiology practices
- 1. HowdotheProposedChangesin2019CMSPhysicianFeeScheduleandQualityPaymentProgramAffect RadiologyPractices? Massachusetts – August, 2018 – This July, CMS released the proposed rules for Physician Fee Schedule and Quality Payment program 2019. Here are some important highlights of the proposed rules and their potential impact to your radiology practice in 2019. The proposed conversion factor, the amount that is multiplied by each procedure’s RVU value, would increase from $35.99 to $36.05. Evaluation and Management Code Changes (E&M Codes) The changes to E&M codes for 2019 include – Providers would be allowed to base E&M coding determination on medical decision-making time apart from the current guidelines. A single rate for E&M levels 2 through 5, to reduce burden and inconsistent application of E&M coding levels between providers. While the rule has not been finalized, this would yield $135.00 for new patients and $93.00 for established patients. Telehealth Services CMS is proposing to pay for the following new applications of technology: Brief communication between provider and patient Remote evaluation of recorded video and or images submitted by the patient Chronic and remote physiologic monitoring Prolonged preventive service Price transparency CMS is seeking to improve price transparency for patients, especially with respect to out-of-pocket expenditure. The agency is also seeking information about what can be done by providers to inform patients of such obligations. Appropriate Use Criteria for Advanced Imaging In 2018, the requirement for using a qualified Clinical Decision Support Mechanism (CDSM) was delayed until January 1, 2020. The 2019 rule reiterates this but CMS will not start denying claims until January 1, 2021 to allow physicians time to test and implement the requirements. Merit Based Payment System (MIPS) Many of the proposed changes will affect the calculations. For example, the proposed changes include – increasing the performance threshold from 15 to 30 points. expansion of Eligible Clinician provider types proposed changing ‘Advancing Care Information’ category to ‘Promoting Interoperability’ category. Reducing the Quality category from 50% to 45%. Increase the Resource Use from 10% to 15%. Since this is a proposal, it is subject to impact by stakeholders’ comments which must be submitted by September 10, 2018. Going by precedence and the stakeholder engagement CMS uses in arriving
- 2. at these proposals, it is likely that many of these proposed changes will be finalized by late November when the final rules are published in the Federal Register. A trusted medical coding, billing and RCM company can help you navigate through changes and updates in coding and billing regulations to maintain and improve the financial health of your practice. To learn more or to take advantage of the top specialty medical billing service company, such as radiology billing services, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.