CHA Provides Details of CY 2019 Physician Fee Schedule Proposed Rule
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The Centers for Medicare & Medicaid Services (CMS) yesterday released its proposed rule updating the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies for calendar year (CY) 2019. The proposed rule includes a number of significant proposals that will impact hospitals and clinicians. While CHA will release a detailed summary of the proposed rule in the coming weeks, key provisions are highlighted below. Comments on the proposed rule are due Sept. 10.
Payment for Non-Excepted Off-Campus Provider Departments: As required by Section 603 of the Bipartisan Budget Act of 2015, CMS pays for items and services furnished at certain off-campus hospital outpatient provider-based departments under a PFS relativity adjuster of 40 percent of the amount that would have been paid for those services under the outpatient prospective payment system. For CY 2019, CMS proposes to maintain the current PFS relativity adjuster at 40 percent.
Evaluation and Management (E/M) Burden: CMS proposes a number of coding and payment changes to reduce the administrative burden and improve payment accuracy for E/M visits. Among the changes, CMS proposes to expand options on how practitioners choose to document E/M visits using medical decision-making or time instead of applying the current documentation guidelines. Practitioners would be allowed to review and verify certain information in the medical record entered by ancillary staff or the beneficiary, rather than re-entering the information themselves. CMS also proposes to establish a new, single blended payment rate for new and established office and outpatient E/M level 2 through 5 visits.