Practice Management Alert

Find out how payments will be adjusted next year to plan for a thriving financial future.

A proposed rule for the eagerly-awaited Medicare Physician Fee Schedule (PFS) was released in mid-July. Stakeholders have until early September to comment on the schedule before it’s finalized in November to go into effect in 2018. You can read the proposed version online here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-14639.pdf.

Help CMS Help You

Before getting to what’s in the PFS, however, CMS is putting out a call to the medical community. It’s asking for input on how the agency can make healthcare delivery less bureaucratic, more efficient and less costly. That can include any regulatory, policy, or process issues that currently frustrate providers and that could be changed to make the system operate more smoothly. Those responding to this request for information should put forward concise proposals, with real-life examples and data if possible.

Changes to Know for 2018

What follows are the major changes in the Medicare PFS that could affect your practice next year:

• Payment rates rise 0.31 percent over 2017 levels. It’s the number you’ve all been waiting for! Yes, MACRA called for 0.5 percent year-by-year increases, but the  ABLE Act adjusts that figure downward by 0.19 percent for 2018 to balance out any codes that might have been mis-valued in the past. The result is a conversion factor of $35.99, up 10 cents from the year before.
• New telehealth codes added. CMS will pay for more remote services, including health risk assessment and psychotherapy for crisis. The rule would also scrap the requirement to report the telehealth modifier.
• Appropriate Use for imaging delayed again. Practices won’t be required to implement the Appropriate Use Criteria Program for advanced diagnostic imaging until 2019, and even then the first year will only be for operations testing.
• New codes for FQHCs and rural clinics. Federally qualified and rural health clinics will now be paid for regular and complex chronic care management services, psychiatric collaborative care models, and general behavioral health integration services.
• Playing field leveled between off-campus hospital departments and practices. One of the most controversial provisions of this schedule is the decision to cut payment rates for certain off-campus provider-based hospital departments in half – 25 percent of the OPPS rate instead of the current 50 percent. The hope is to align the rates more closely with physician practices in order to increase competition. Needless to say, hospitals are up in arms over these cuts, arguing that they make it more difficult to operate outpatient clinics in under-served communities.
• E/M Guidelines to be revised at last. CMS is soliciting feedback on how to update the frustrating Evaluation and Management Visit codes. To receive payment under the current rules, physicians must gather a considerable amount of information. The hope going forward is to change or even eliminate the History and Exam guidelines, placing more emphasis on the Medical Decision Making guideline and the amount of time spent on the service.
• Diabetes Prevention expanded. The rule would pay for the expanded model of the Medicare Diabetes Prevention Program, which intervenes to treat pre-diabetic patients. Providers who offered the program would now receive payment for their patients achieving a more realistic set of goals than in past years.
• Higher payments offered for behavioral health. The fee schedule proposes boosting pay for in-office behavioral health services, particularly those related to fighting addiction to opioids and other substances. This helps to offset the overhead costs of running an office where therapy and counselling services are offered.