Ophthalmology and Optometry Coding Alert

And get to know these other potential changes on deck for 2019.

The proposed E/M changes that may be scheduled for January could impact your eye care practice, but those aren’t the only proposals that may affect you. Read on for other updates which could be relevant to you.

Conversion Factor Change Isn’t Riveting

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.”
• 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.

Check the Final Calculations

Based on all of the proposed changes, CMS projects that independent laboratories lead the pack of specialists who will prosper in 2019 if the proposed fee schedule is finalized, with an estimated combined increase of four percent, while rheumatologists, hematologists/oncologists, and diagnostic testing facilities look to see the biggest declines at minus four percent. Eye care specialists aren’t facing either extreme, as the fee schedule indicates that under the proposal, ophthalmologists would see a payment decrease of one percent, while optometrists would get a pay boost of one percent.