3 Things You Need to Know About 2019 Medicare Payments

Anders Gilberg

Disclosures

December 12, 2018

Take Advantage of Virtual Care Opportunities

Physician practices can look forward to new virtual service opportunities taking effect on January 1, 2019. Previously, Medicare only covered "telehealth services" in designated rural areas. Thanks to the 2019 fee schedule, physicians can now provide virtual services without geographic limitations and in nonclinical settings (ie, the patient's home).

Owing to the restrictions within the legal definition of "Medicare telehealth services," Medicare telehealth has been slow to reach beneficiaries. Recognizing limitations, CMS took a clever approach and circumvented statutory constraints to allow for broader virtual care by designating a new class of "communication technology-based services" outside the statute's reach.

Communication technology-based services create new opportunities for physician reimbursement (contingent on patient consent and other billing criteria) for the following services:

  • Evaluating patient-submitted videos and images;

  • Brief telephone check-ins with patients;

  • Interprofessional consultations; and

  • Remote patient monitoring.

The response to these changes has been widely supportive. These new Medicare-covered services will allow physicians to be rightfully reimbursed for services they were previously providing without payment and for supporting patient care outside of the traditional office visit.

EHR Upgrade Requirements

2015 Edition Certified EHR Technology will be required for the promoting interoperability component of the Merit-based Incentive Payment System (MIPS), as well as for any participant in an advanced alternative payment model, starting January 1, 2019.

It may seem reasonable that CMS would require 2015 edition technology in 2019, but the pushback reflects the difficulty of physician practices forced to constantly upgrade or replace EHR programs to meet Medicare quality reporting requirements.

The struggle of EHR upgrading is particularly felt among smaller physician practices. Some of these practices defer upgrades because of cost or disruption, whereas others' vendors don't even offer the latest EHR edition.

It's to be expected that the transition period for practices upgrading will be a rocky one—and those who choose to not upgrade must meet their MIPS requirements through other categories or face a penalty.

It's to be expected that the transition period for practices upgrading will be a rocky one—and those who choose to not upgrade must meet their MIPS requirements through other categories or face a penalty. Years after the original meaningful use debacle, it is unfortunate that the government still believes it knows better than physicians when it comes to EHRs.

Weighing Pros and Cons

In a recent MGMA survey, physician practices cited a significant 86% increase in regulatory burden since last year. Unsurprisingly, Medicare's quality reporting programs were ranked as the most burdensome regulatory issue, with 88% of respondents citing it as very or extremely burdensome.

Some of the steps taken within the Physician Fee Schedule final rule will help alleviate these burdens, but we have a long way to go to truly put patients over paperwork. CMS must work with the physician community to meaningfully reduce the regulatory burden and allow practices to allocate precious time and resources to providing high-quality care that meets the needs of their unique patient population.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....