Once a year, the Centers for Medicare and Medicaid Services (CMS) reviews the physician fee schedule for desired modifications to take affect the following year. This review process has begun for 2019.
As a quick reminder of the process, CMS publishes their Fact Sheet inclusive of the Proposed Rules for 2019 reimbursement plans in July, to solicit industry feedback until September 10th. CMS will then consider the feedback and make adjustments to their Proposed Rule in the fall. The Final Rule for payment and policy changes is then published in Q4 of this year, with an effective date of January 1, 2019.
One of CMS’s stated goals for 2019 is to reduce the administrative burden on physicians. As you know, the current methodology for Evaluation and Management (E/M) Services, established back in 1997, has five E/M levels for new patients (codes: 99201-99205) and five E/M levels for established patients (codes: 99211-99215). Each of these codes have different fee schedule amounts and correspond with tightly prescribed documentation requirements in the EMR.
Under this proposed rule, CMS would streamline the coding and documentation requirements for physicians when it comes to office visits. It would reduce the amount of direct physician documentation required and allow for physicians to approve clinical information entered into the EMR by ancillary staff.
Other proposed changes include, allowing payments for telemedicine visits and increasing the requirements on hospitals and medical groups to publish their fee schedules.
We strongly encourage all medical groups to read the Fact Sheet to understand the comprehensive list of proposed changes, and to provide comments to CMS before the September 10th deadline.
