Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2018

Date

2017-07-13

Title

Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2018

Contact

press@cms.hhs.gov

Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2018

On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018.

The calendar year (CY) 2018 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.

Background on the Physician Fee Schedule

Payment is made under the PFS for services furnished by physicians and other practitioners in all sites of service. These services include, but are not limited to, visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services.

In addition to physicians, payment is made under the PFS to a variety of practitioners and entities, including nurse practitioners, physician assistants, and physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities.

Payments are based on the relative resources typically used to furnish the service. Relative Value Units (RVUs) are applied to each service for physician work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute.

Read more at:  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-07-13-2.html

MIPS Overview

If you decide to participate in the Merit-based Incentive Payment System (MIPS), you will earn a performance-based payment adjustment to your Medicare payment.

How Does MIPS Work?

You earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by sending in information in the following categories.

 

Quality

Replaces PQRS.

 

Improvement Activities

New Category.

EHR

Advancing Care Information

Replaces the Medicare EHR Incentive Program also known as Meaningful Use.

Cost

Replaces the Value-Based Modifier.

The cost category will be calculated in 2017, but will not be used to determine your payment adjustment. In 2018, we will start using the cost category to determine your payment adjustment.

 

Quality

2017

Improvement Activities

2017

EHR

Advancing Care Information

2017

Cost

2018

 

Read more at:  https://qpp.cms.gov/mips/overview

Emergency Department Visit, 99285 - Widespread Service Specific Targeted Review Notification

Noridian is initiating a service specific targeted review for CPT ® 99285 - Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life of physiologic function. This will affect all states/territories with the following CPT ® 99285. Noridian Part B Medical Review has analyzed national and local data to identify atypical billing.

View the Emergency Department Visit, 99285- Widespread Service Specific Targeted Review Notification.

Last Updated Mar 22, 2016

https://med.noridianmedicare.com/web/jeb/article-detail/-/view/10525/emergency-department-visit-99285-widespread-service-specific-targeted-review-notification