Orthopedic Coding Alert

Question: I know that Medicare usually releases its final rule on the Medicare physician fee schedule (MPFS) late in the year. So, what's the MPFS look like next year? What can we expect from Medicare?

Oregon Subscriber

Answer: Take a look at the Medicare Physician Fee Schedule (MPFS) final rule for CY 2018, which CMS released in November: www.gpo.gov/fdsys/pkg/FR-2017-11-15/pdf/2017-23953.pdf.

Here's a few highlights from the final rule, which goes into effect on January 1, 2018.

A break on paperwork: Stakeholder input matters to CMS, the MPFS fact sheet suggests. A new program launched last month and outlined in the final rule addresses medical groups' complaints that administrative burdens are impeding patient care. "The Patients Over Paperwork Initiative" aims to improve collaboration and care by streamlining "regulations with a goal to reduce unnecessary burden, increase efficiencies, and improve the beneficiary experience," noted CMS in a release.

"During my visits with clinicians across the country, I've heard many concerns about the impact burdensome regulations have on their ability to care for patients," said Seema Verma, CMS Administrator. "These rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over volume of tests, and encouraging innovation and competition within the American healthcare system."

The final rule implements "Patients Over Paperwork" by cutting down data reporting and "removing downward payment adjustments based on performance for practices that meet minimum quality reporting requirements," says the MPFS fact sheet.

"Our overall vision is to reinvent the agency to put patients first," declared Verma about the initiative during her address at the Health Care Payment Learning and Action Network (LAN) Fall Summit. "We want to partner with patients, providers, payers, and others to achieve this goal."

Telehealth gets another bump: CMS continues to invest in telehealth as Medicare moves beyond the traditional venues to more alternative settings for enhanced patient care. However, the fact sheet noted that stakeholder input was mixed on the new options, as some clinicians felt the codes don't support new technologies or are too broad to be fully realized.

Also:  CMS dropped the GT modifier (Via interactive audio and video telecommunication systems) and will no longer require it for telehealth claims. "Anytime a billing requirement is removed it is positive; one less regulation to potentially 'trip over,'" says Vinod Gidwani, founder and president of Currence Inc. in Skokie, Illinois (medcurrence.com). "Telemedicine will continue to expand and its potential to bend the cost curve is one of the positive innovations taking place in healthcare."

E/M rules: The jury is still out on proposed evaluation and management (E/M) documentation changes that impact the level of code providers use - which also happens to impact the amount providers are paid - as CMS continues to weigh stakeholders' comments. Despite admitting that the current requirements are "potentially outdated and need to be revised," the agency did not move forward with revisions like it originally proposed in July.