Physicians should be aware of proposed 2019 Medicare QPP rule

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• Physicians should be aware of proposed 2019
  Medicare QPP rule

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Physicians should be aware of proposed 2019
Medicare QPP rule
Centers for Medicare Medicaid Services (CMS)
recently published the proposed Physician Fee
Schedule Rule for 2019. It includes provisions
for the Quality Payment Program (QPP) for 2019 as
well as the physician fee schedule. The
Physician Fee Schedule is a complete listing of
all the fees used by Medicare to pay doctors or
other providers and suppliers. Every year this
comprehensive listing of fee maximums is updated.
Physician or other providers are reimbursed on a
fee-for-service basis using this list.
Reimbursement rates are also differentiated
according to different medical specialties. The
proposed rule also includes several changes to
the MACRA Quality Payment Program (QPP) for the
2019 participation period. In previous years, CMS
published separate proposed rules for the fee
schedule and QPP. It was anticipated that as QPP
Matured, the QPP provisions would be incorporated
into the MPFS rule instead of continuing to
publish stand-alone rule. 2019 seems to be the
year that transition will happen. CMS has
proposed a modest set of changes to the program
for the 2019 performance period that will
determine payment rates for 2021. CMS is
proposing changes to eligibility requirements,
coding, some documentation requirements and how
certain categories are weighted, among others,
with a goal of streamlining billing and expanding
access to high-quality care.
Medical Billing Services in Oregon
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Physicians should be aware of proposed 2019
Medicare QPP rule
CMS has added a third criterion for determining
MIPS eligibility with respect to the low-volume
threshold. To be excluded from MIPS in 2019,
clinicians or groups would need to meet one of
the following three criteria have 90K in Part
B allowed charges for covered professional
services, provide care to 200 beneficiaries, or
provide 200 covered professional services under
the Physician Fee Schedule. Any doctor who met
this requirement or one of the previous two
90,000 or less in Part B charges or caring for
200 or fewer Medicare beneficiarieswould be
exempt from the QPP. CMS has also introduced
facility to opt-in to the Merit-based Incentive
Payment System (MIPS). Any clinician or group
that did not meet all of the low-volume
exemptions could choose to opt-in to MIPS, if
they wish. However, the decision to opt-in is
irreversible. As per the proposal, payment
adjustments for the 2019 performance period (2021
payment period) increase to 5 percent. CMS is
proposing to increase the MIPS performance
threshold for neutral adjustments from 15 to 30
points in 2019. This performance threshold
defines the total points required to earn a
neutral payment adjustment and avoid a negative
payment adjustment. MIPS-eligible clinicians who
score higher than the threshold (31 points and
above) may earn a positive payment adjustment for
2021. CMS is proposing to increase the
exceptional performance bonus threshold from 70
points to 80 points. Bonus points are maintained
for small practices, care for complex patients
and end-to-end reporting but proposes to add
three points to the quality performance category,
rather than adding five points to the MIPS final
score.
Medical Billing Services in Oregon
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Physicians should be aware of proposed 2019
Medicare QPP rule
CMS defines small practices as 15 or fewer
clinicians. There will be changes to general
performance category weights used to calculate
MIPS scores. Quality would decrease from 50
percent of the total to 45 percent, while cost
increases from 10 percent to 15 percent.
Promoting interoperability (formerly called
advancing care) and improvement activities remain
at 25 percent and 15 percent of the total score,
respectively. CMS has also removed 34 quality
measured that it deemed to be of low value. One
notable change from the 2018 QPP rule that
physician advocates lobbied for but did not
receive was to have 90-day reporting periods for
all four performance categories. Instead, quality
and cost will remain 12-month reporting periods
and improvement activities and promoting
interoperability will remain at 90-day reporting
periods.
Medical Billing Services in Oregon