Urology Coding Alert

Staggered approach won’t take full effect until 2021.

Practitioners across multiple specialties were shocked last summer when CMS first announced its proposed changes to the 2019 Medicare Physician Fee Schedule (MPFS). The proposed rule included massive changes to E/M reporting, including how some of the most common E/M codes would be documented and reimbursed. The final rule released on Nov. 1 and set for publication on Nov. 23, 2018, in the Federal Register paints an easier-to-swallow plan for 2019.

“Today’s rule finalizes dramatic improvements for clinicians and patients and reflects extensive input from the medical community,” said CMS Administrator Seema Verma in a release on the MPFS. “Addressing clinician burnout is critical to keeping doctors in the workforce to meet the growing needs of America’s seniors.”

Verma maintained that the policies would decrease provider “burnout” and improve patient care. Plus, “it also delays even more significant changes to give clinicians the time they need for implementation and provides time for us to continue to work with the medical community on this effort,” she said of the final rule.

Your input counted: Despite positive reviews from providers about the paperwork reductions and E/M coding and payment reforms, practices commenting on the rule remained worried about implementing the changes so quickly — to say nothing about the single blended-payment rate change-ups, suggested the MPFS. In fact, most were in favor of streamlining documentation requirements that often bump up denials. The aggressive pace that CMS was pushing to put its plan in place, however, caused some stakeholders to question how they could have their practices and systems up and running for a 2019 rollout.

“Commenters largely objected to our proposal to eliminate payment differences for office/outpatient E/M visit levels 2 through 5 based on the level of visit complexity,” the MPFS noted. The consensus was that most would see significant pay cuts under the change, and many suggested the agency “implement the proposed documentation reduction without the coding/payment policies, or that these policies could be adopted on separate time frames,” the final rule indicated.

Bottom line: More changes are coming, but CMS has resolved to implement E/M updates over the course of two years, with only a few subtle modifications for CY 2019, Stay tuned for more details about what to expect in 2019 and beyond in the next issue of Urology Coding Alert.