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Reimbursement Feature

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CMS Releases 2018 Physician Fee Schedule

Walter Eisner • Tue, November 28th, 2017

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On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule Final Rule for 2018. The final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018.

Electronic Health Records and Quality Measures

Among other things, the final rule governs physicians’ adoption of electronic health records (EHR) and rewards them for meeting quality measures when treating Medicare patients. The final rule includes some changes that mean that fewer physicians will be required to participate.

Under the Quality Payment Program, providers can choose two tracks: The Merit-Based Incentive Payment System (MIPS), or the Advanced Alternative Payment Model (APM). Most physicians fall under MIPS.

According to the Association of Health Care Journalists, here are a few highlights of the final rule:

  • Physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients are exempt from the program.
  • Physician practices impacted by recent hurricanes in southern states can receive a hardship exemption.
  • Only about 40% of the 1.5 million physicians who treat Medicare patients will be participating in the MIPS program.
  • New billing codes will allow physicians to get reimbursed for some types of virtual visits.
  • Small, solo and rural physicians can band together and form “virtual groups“ to participate in MIPS, with a deadline of December 1 for the 2018 performance year.
  • Physicians can use either 2014 or 2015 certified EHR technology in 2018—but Medicare gives a 10% bonus to those using the newer 2015 version.

AAOS Supportive

The American Academy of Orthopaedic Surgeons (AAOS) was supportive of the CMS proposals to fully align CMS quality programs like the Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the resource Value-Based Payment Modifier (VBPM). These programs compose three of the four categories of measurement under the QPP MIPS but the legacy programs (PQRS, MU and VBPM) remain in effect for 2018.

The Academy was supportive of the rule which calls for retroactively meeting minimum thresholds for positive or neutral payment adjustments for 2016 that will match the thresholds under QPP MIPS because it will make it easier for physicians to get positive or neutral payment adjustments in 2018.

To see the entire rule, click here.

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