Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
On November 2, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018.nnThe overall update to payments under the PFS based on the finalized CY 2018 rates will be +0.41 percent. This update reflects the +0.50 percent update established under the Medicare Access and CHIP Reauthorization Act of 2015, reduced by 0.09 percent, due to the misvalued code target recapture amount, required under the Achieving a Better Life Experience Act of 2014. After applying these adjustments, and the budget neutrality adjustment to account for changes in Relative Value Units, all required by law, the final 2018 PFS conversion factor is $35.99, an increase to the 2017 PFS conversion factor of $35.89.nnThe Final Rule Includes:n
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- Patients over Paperwork Initiative
- Changes in valuation for specific services
- Payment rates for nonexcepted off-campus provider-based hospital departments
- Medicare telehealth services
- Malpractice relative value units
- Care management services
- Improvement of payment rates for office-based behavioral health services
- Evaluation and management comment solicitation
- Emergency department visits comment solicitation
- Solicitation of public comments on initial data collection and reporting periods for Clinical Laboratory Fee Schedule
- Part B drugs: Payment for biosimilar biological products
- Part B drug payment: Infusion drugs furnished through an item of durable medical equipment
- New care coordination services and payment for rural health clinics and federally-qualified health centers
- Appropriate use criteria for advanced diagnostic imaging
- Medicare Diabetes Prevention Program expanded model
- Physician Quality Reporting System
- Patient relationship codes
- Medicare Shared Savings Program
- 2018 Value Modifier
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nClick here to read original releasennThis article originally posted on cms.gov.
Unfortunately, many healthcare providers are missing out on things like electronic billing, email capture.nnA new survey by the Medical Group Management Association suggests providers, especially hospitals, are missing out on key areas to improve when it comes to patient billing, payments and satisfaction.nnThe Digital Payments Progress report, a product of a partnership with medical claims management company Navicure, is a national survey conducted among MGMA member organization this past May.nnThe report shows that physician practices seem to have the advantage when it comes to billing and payments. For instance, 79 percent of ambulatory organization respondents can generate a cost estimate upon request, while only 69 percent of hospital respondents can do so.nnAlso, 64 percent of group practice respondents reported patients are comfortable sharing their email address, while only 56 percent of hospital respondents had that perception.n“In actuality, 79 percent of patients report feeling comfortable providing their email address. This represents an opportunity to leverage email addresses to deliver bills electronically, saving the industry millions of dollars in cost, environmental waste and days in A/R,” the report said.nnThere are also other key areas where all providers could be doing a better job of playing to the needs and wants of consumers. Despite a majority of patients’ preference for electronic billing, 52 percent specifically, 77 percent of respondents still send paper bills. A similar study conducted in January by Navicure and Himss Analytics showed the same trend, with 52 percent of patients preferring electronic billing but 89 percent of providers saying they still used regular mail.nnThe HIMSS/Navicure study also showed keeping a credit card on file is something that 78 percent of patients approve of for small charges totaling less than $200 but only 20 percent of providers used this method.nnThe Progress Report echoed this notion, with results showing CCOF would be highly beneficial to revenue cycle management, and ultimately a provider’s bottom line. It helped reduce patient bad debt/write off, according to 36 percent of respondents, and 34 percent said it cut days in patient A/R and cost of collections, the report said.nnIn an age of consumerism, where patients are paying more out-of-pocket costs and shopping around for providers and services, practices and hospitals alike would do well to pay attention to these trends among patients, who now act more like retail consumers who go where their needs and preferences are met. Consumers have voiced a willingness to switch providers in order to have services like telehealth available to them. Chances are, as they become even more discerning and demanding, something seemingly small like electronic billing could prove pivotal when it comes to keeping patients’ business.nnThis 
MI code updatesnnThe list of ICD-10 code updates is extensive and Myocardial Infarctions got a makeover with this year’s revision. Code category I21 has been renamed from “ST elevation and non-ST elevation myocardial infarction” to “Acute myocardial infarction”. Additional specificity options now include type 1, type 2, and other MI types. Providers will need to specify in clinical documentation the type of MI the patient experienced. STEMI codes (I21.0 and I21.1) are now defined as Type 1 MIs. New codes I21.A1 – MI type 2 and I21.A9 – other MI type are also important and notable additions.
WASHINGTON — President Trump reversed course Wednesday and threw cold water on a new bipartisan congressional health care plan designed to maintain subsidies for health insurance exchanges, thereby temporarily propping up the Affordable Care Act.nnA day after signaling support for the plan developed by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., Trump tweeted Wednesday that the deal might benefit insurance companies too much.nnAlexander, in a series of tweets Wednesday, indicated the deal may still have a chance. After getting a phone call from Trump, he wrote that he agrees the subsidies should benefit consumers and not insurers.nn”The Alexander-Murray agreement has strong language to do that, and I will work with the president to see if we can make it even stronger,” Alexander tweeted.nnMurray and Alexander have been drafting a bill for several months to boost the insurance marketplace, but the effort took on new urgency last week when Trump announced he would no longer fund the subsidies without congressional action.nnWhile House and Senate Democratic leaders said they support the compromise, Republican leaders aren’t eager to bring it to the floor for a vote.nnHouse Speaker Paul Ryan’s press secretary, Doug Andres, said in a Wednesday statement, “The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare.”nnOn Tuesday, Senate Majority Leader Mitch McConnell, R-Ky., told reporters, “We haven’t had a chance to think about the way forward yet.”nnRegardless of Trump’s position, the deal’s Senate supporters will pursue an even number of bipartisan cosponsors to help build pressure for a vote, Senate Minority Leader Chuck Schumer of New York told reporters Wednesday.nn”I spoke to Senator Alexander this morning, and I encouraged him, ‘Let’s go forward, period,’ and he’s game,” Schumer said. Once cosponsors are lined up, Schumer said he’ll ask McConnell for a vote.nn”If that happened, I would be quite certain it would pass…and then there would be pressure on the House,” he said. “If the president will come out strongly for the bill and stick to that, that will help us get it through the House.”nnAlexander also said Trump and the House will have to consider the agreement once more senators are on board.n
Physician practices may begin data collection as late as December 31 and still avoid the negative payment adjustment.nnOctober 2, 2017, marked practices’ deadline to begin collecting data for the Centers for Medicare & Medicaid Services’ (CMS) “pick your pace” option two under the merit-based incentive-payment system (MIPS) track of the Medicare Access and CHIP Reauthorization Act (MACRA).nnFor this transition year of the 
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