CMS Released CY 2019 Physician Fee Scheduled Proposed Rule
Yesterday CMS released their CY 2019 physician fee schedule proposed rule, which includes major proposed changes to E&M coding. Below is my review of this component of their propose rule, including page references to the source in the federal register.nnWe all know E&M coding has it flaws, and 1995/1997 guidelines could not have accounted for changes in technology today, especially the EHR. Furthermore, many consider E&M guidelines as being too complex, ambiguous and incapable of meaningfully distinguishing between different code levels. For some time, physicians and other stakeholders have asked CMS to undergo extensive research to overhaul both the E&M documentation guidelines and the underlying coding structure. You would essentially blunt any potential benefit by updating one and not the other. Based on all of the feedback provided thus far, CMS begins their proposal by defining a number of trends which emerged from the feedback:nn• Substantially different recommendations came in by specialty; any changes would have both clinical and financial specialty-specific impactsn• History and exam portions of the guidelines are most significantly outdated; they should be simplified or reduced, but not eliminatedn• Medical decision making should be given more weight in determining visit level, but those specific guidelines should be updated as welln• Reduce E&M levels generally into three, such as low / medium / high, and also correlate these to timenn n
nThis article was originally posted on implementhit.com
As the CMS charts a path to level pay for outpatient services, it’s also leading toward a head-to-head battle with powerful hospital lobbying groups as some providers win and lose with site-neutral payments. Check out the article, below, for more information!
Major changes are in store for the Merit-based Inventive Payment System (MIPS) in 2019, as the Trump administration pushes to reduce the record-keeping burden shouldered by clinicians. Continue reading, below, for why you should be prepared for these changes as soon as next year.nnIn a slate of proposals released late last week, the Centers for Medicare & Medicaid Services outlined 10 new quality measures it would like to add to the MIPS program, plus dozens it wants to remove. The measures on the chopping block are process-based items clinicians have identified as “low-value or low-priority,” CMS said.nnThe agency also proposed changes to the MIPS “promoting interoperability” performance category. The changes are designed to improve interoperability of electronic health record (EHR) data, give patients easier access to their own health data, and align the performance category with a similar proposal for hospitals.nnThese proposed changes to the Quality Payment Program are good news, said Gerald Maccioli, MD, MBA, FCCM, chief quality officer for Envision Healthcare.nn”As a country, we continue on a positive and productive pathway to figuring out how to use quality measures to markedly improve the health of our communities, and with the proposed changes CMS is moving in the right direction,” Maccioli said in a statement.n
The Centers for Medicare & Medicaid Services (CMS) hopes physicians would no longer have to predict how much longer a particular Medicare patient will need home care in order to have the service re-certified, according to a regulation they proposed Monday. nn”In an effort to make improvements to the health care delivery system and to reduce unnecessary burdens for physicians, CMS is proposing to eliminate the requirement that the certifying physician estimate how much longer skilled services are required when recertifying the need for continued home health care,” the agency said in a fact sheet about the proposed rule.nn”This proposal is responsive to industry concerns about regulatory burden reduction and could reduce claims denials that solely result from an estimation missing from the recertification statement. We estimate that this proposal would result in annualized cost savings to certifying physicians of $14 million beginning in [calendar year] 2019.”nnIn addition to eliminating that requirement, “we’re releasing several proposals to modernize Medicare by increasing access to remote patient monitoring,” CMS administrator Seema Verma said Monday on a phone call with reporters.nn”This will allow more patients to share real-time data [with providers]. Last year we made changes to allow physicians to bill for remote patient monitoring,” she said. “Home health agencies, however, couldn’t bill for the new code. So in today’s proposal we address that disparity.”nnCMS also is beginning to implement a new home infusion therapy benefit — using a transitional payment until the full benefit takes effect in 2021 — and proposing health and safety standards for home infusion therapy.n
Join us for an open house to gain more information about the changes that are coming to health care this summer. We will discuss the next phase of the Accountable Care Collaborative (ACC 2.0), Colorado’s innovative approach to improving the experience and outcomes of both physical and behavioral health care services for people who are part of Health First Colorado (Colorado’s Medicaid program). Learn how these changes will affect you and your patients.