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Learn How Part B Payment is Changing for Practitioners

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  • November 20, 2018
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Learn How Part B Payment is Changing for Practitioners

Monumental changes to Medicare policy finalized in the 2019 Physician Fee Schedule (PFS) final rule warranted a Centers for Medicare & Medicaid Services (CMS) national call, held Nov. 19. Here’s a summary of what you may have missed.

First Up: Evaluation and Management Services

CMS started out with an explanation of the Patients Over Paperwork initiative, and how changes being made to documentation requirements and payment for evaluation and management (E/M) services will support the initiative.

The Patients Over Paperwork initiative is focused on reducing administrative burden while improving care coordination, health outcomes and patients’ ability to make decisions about their own care. — CMS

To that end, for 2019 and beyond, healthcare practitioners who conduct a home visit in lieu of an office visit need not document the medical necessity for the place of service. CMS is also eliminating the requirement for practitioners to re-record required history and exam elements for established patient office/outpatient visits when the information already exists in the medical record. Practitioners may simply review the information and update it, as needed. CMS also clarifies in the final rule that practitioners need only review and verify information entered in the medical record by ancillary staff or the patient.
Beginning in 2021, CMS will implement payment, coding, and additional documentation changes for E/M office and outpatient visits. For details on these changes, read:
Single Payment on the Horizon
Medicare reconsiders Same-Day E/M Services
No Changes to E/M Payment Until at Least 2021

Next on the Agenda: Virtual Care

In the interest of supporting new communications technology, CMS finalized policies to:

  • Pay clinicians for virtual check-ins;
  • Pay clinicians for remote evaluations of patient-submitted photos or recorded videos;
  • Pay rural health clinics (RHCs) and federally qualified health centers (FQHCs) for these kinds of services outside of the RHC all-inclusive rate and the FQHC Prospective Payment System rate;
  • Expand Medicare telehealth services to include prolonged preventive services;
  • Implement policies from the Bipartisan Budget Act of 2018 for telehealth services related to end-stage renal disease patients receiving home dialysis and patients with acute stroke; and
  • Implement SUPPORT for Patients and Communities Act policy to expand telehealth services for treatment of opioid use disorder and other substance use disorders.

Last but Not Least: Quality Payment

Ticking all the boxes, CMS also spent some time during the call to touch on Year 3 policy for the Quality Payment Program. Most notable include the expansion of MIPS eligible clinicians; the addition of a third criterion for calculating the low-volume threshold that determines eligibility; the change in performance category weights; and the increase in the performance threshold.
For more information on these and other policy changes to MIPS, read:
CMS Discloses Requirements for Positive Payments Under MIPS in 2021

Event materials for the Physician Fee Schedule Final Rule: Understanding 3 Key Topics Call are available on the CMS website.
Download the E&M Payment Chart for easy reference.
Download the 2019 PFS final rule from the CMS website.

Evaluation and Management – CEMC

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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