On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule
updating payment policies and payment rates for physicians under the Medicare Physician Fee Schedule (MPFS) for 2018. CMS estimates a 0% impact in payment for neurology and physical medicine and rehabilitation physicians.
A few key item addressed in the 2018 MPFS final rule include:
Evaluation and Management (E/M) Guidelines. CMS is proposing a multi-year effort to revise the Evaluation and Management Guidelines in an effort to reduce administrative burden to physicians. CMS suggests that greater importance be placed on medical decision making and time spent performing the service while eliminating the focus on the guidelines related to history and physical examination. While no specifics were finalized in this rule, CMS solicited comments and feedback from stakeholders regarding potential future revision.
Telehealth services. CMS finalized the addition of several codes to the list of telehealth services including codes for Interactive Complexity, Care Planning for Chronic Care Management, and Health Risk Assessment. CMS also finalized their proposal to eliminate the required reporting of the telehealth modifier GT for professional claims in an effort to reduce administrative burden for practitioners.
Patient Relationship Categories. The Medicare Access and CHIP Reauthorization Act (MACRA) directed CMS to create new patient relationship codes that physicians would be required to report on claims starting in 2018 for the purposes of determining which physician would be held accountable for a patient’s cost of care. CMS finalized 5 patient relationship categories that are identified with the use of modifiers. CMS also finalized a policy regarding the reporting of Healthcare Common Procedure Coding System (HCPCS) modifiers; these may be reported voluntarily by clinicians associated with these patient relationship categories beginning January 1, 2018.
PQRS and MU Quality Reporting. In order to align the Physician Quality Reporting System (PQRS) CY2016 and Meaningful Use (MU) quality reporting requirements with the new quality reporting requirements under the Merit-based Incentive Payment System (MIPS) which began on January 1 of this year, CMS is finalizing revisions to CY2016 PQRS and MU quality reporting requirements to only require physicians to report 6 measures with no domain or cross-cutting measure requirements.
Value-based Modifier (VM). CMS is finalizing their proposal to hold all groups and solo practitioners who met 2016 PQRS reporting requirements harmless from any negative VM payment adjustments in 2018 as well as to halve penalties for those who did not meet PQRS requirements to -2 percent for groups with 10 or more eligible professionals, and to -1 percent for smaller groups and solo practitioners.
A more detailed analysis of changes to the RVUs related to EDX and neuromuscular medicine is forthcoming. Please contact the policy department at firstname.lastname@example.org
with any questions or concerns.