Medicare Compliance & Reimbursement

Health IT permeates suggested policy changes heading into 2019.

Across the board, the Medicare Physician Fee Schedule (MPFS) proposals keep the agency’s “Patients Over Paperwork” pledge on the federal healthcare delivery plate. Every aspect of the proposed rule promotes CMS’s heightened focus on utilizing health IT to enhance care and cut costs while decreasing clinicians’ workloads.

Here are a few of the highlights from the 1,000-page-plus CY 2019 MPFS proposed rule:

• Conversion factor: Lower than last year’s 10-cent bump, the conversion factor proposal is nothing to write home about at a 6-cent increase for inflation and slated to go from $35.99 to $36.05.
• QPP. The MPFS proposals include transition updates, cost and quality scoring changes, threshold guidance, small practice bonus downgrades, and several tech-friendly policies that bring Promoting Interoperability (PI) to center of MIPS.
• Telehealth. Two more codes for telehealth — HCPCS codes G0513 and G0514 (Prolonged preventive service(s)) — as well as 2018 Bipartisan Budget Act telehealth requirements for end-stage renal disease (ESRD).
• Virtual care. Payment increases for the use of audio and visual communication that “leverage technologies.”
• Part B Drugs. The proposed rule wants to see beneficiaries get their meds for less. “Effective January 1, 2019, [wholesale acquisition cost] WAC-based payments for new Part B drugs during the period first quarter of sales when ASP is unavailable, the drug payment add-on would be 3 percent in place of the 6 percent add-on that is currently being used,” the fact sheet advises.
• Medicare Advantage. MIPS requirements would be waived for Medicare Advantage providers interested in participating in the QPP. The program will be called the “Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration” and is for clinicians whose “arrangements are similar to Advanced APMs,” explains the fact sheet.

“Today’s reforms proposed by CMS bring us one step closer to a modern healthcare system that delivers better care for Americans at a lower cost,” said Alex Azar, HHS Secretary in a press statement. “Such a system requires empowering American patients by giving them price and quality transparency and control over their own interoperable health records, goals supported by CMS’s proposals.

Next steps: This is just a part of what CMS mentions in the CY 2019 MPFS proposed rule, released on July 12 and published officially in the Federal Register on July 27. Other updates impact clinical lab and ambulance fee schedule changes, therapy services, practice expenses (PEs), price transparency, new procedure codes and code revaluations, the Stark Law, and more.

Medicare Compliance & Reimbursement will continue to piece apart the many proposals in the coming months.

Resource: For a closer look at the MPFS proposed rule for CY 2019, visit https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf.