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Citing the need to reduce paperwork hassles, officials at the Centers for Medicare & Medicaid Services are proposing to flatten the payment for evaluation and management (E/M) visits coded at levels 2-5.
The CMS outlined how the proposal would affect payment using 2018 rates to model the change. The proposal would set the payment rate for level 1 E/M office visits for new patients at $44, down from the $45 using the current methodology. Levels 2-5 would receive $135. Currently, payments for level 2 visits are set at $76, level 3 at $110, level 4 at $167, and level 5 at $211.
For office visits with established patients, the proposed rate would be $24, up from the current payment of $22 for a level 1 visit. Levels 2-5 would receive $93. Under the current methodology, payments for level 2 visits are set at $45, level 3 at $74, level 4 at $109, and level 5 at $148.
The change also comes with a reduced documentation burden, so the same documentation is needed regardless of which level between 2 and 5 the office visit is, a move that is expected to save time.
The CMS outlined its vision for changes to the E/M payment in the proposed update to the 2019 Medicare physician fee schedule. Comments on the proposal are due Sept. 10, 2018.
The agency estimated that for most specialties, there would be minimal effect on this proposed change. However, for 10 specialties, payment reductions could result from this change. The proposal is raising concerns, particularly from those who stand to see their pay reduced.
CMS officials estimate the proposal would save time. CMS Administrator Seema Verma said that the documentation change would result in an additional 51 hours for patient care per clinician per year.
“The agency has clearly heard from physicians about the need to reduce administrative burdens for physicians,” stated Lisa Gangarosa, MD, AGAF, chair, AGA Government Affairs Committee. “In that regard, CMS should be commended. Unfortunately, in their efforts to reduce burden, CMS has proposed changes that drastically undervalue the care gastroenterologists and hepatologists provide to patients with inflammatory bowel disease, motility disorders, chronic liver disease and other complex gastrointestinal diseases.”
Angus B. Worthing, MD, chair of the American College of Rheumatology’s Committee on Government Affairs, said he was doubtful that any increase in volume would offset the losses from the proposed flat payment across levels 2-5 E/M visits, especially if the pay decrease results in access issues.
SOURCE: CMS proposed rule, CMS-1693-P.
On July 12, 2018, CMS published a set of “proposed rules” that will have substantial impact on your practice. CMS released a 665-page document with 26 proposed changes in Medicare. A public comment period is open until Sept. 10, 2018. Final rules will be published in the fall with implementation expected in January 2019.
Medicare proposes to reduce the number of E/M coding levels to two (from five: these relate to current CPT codes 99201-99205 and 99211-99215), with documentation requirements reduced to those required for current level 2. If you tend to bill levels 4-5, your bottom line will be affected.
CMS wants to eliminate site-of-service differences in both clinic and ASC payments. This will modify the financial advantages gained by practices who sold their centers to hospital systems and for health systems that have HOPD endoscopy centers and clinics.
Endoscopy with biopsy and colonoscopy with polypectomy were again identified as being potentially overvalued and thus may trigger a re-analysis.
A policy change announced recently by CMS would allow Medicare Advantage plans to establish sequence requirements (step therapy) for medical therapies, including biologics.
While community practices clearly will be affected by these changes, the financial pressures on academic medical centers will be immense. AMC’s have high fixed costs and deteriorating clinical margins. Clinical revenue supports not only clinical enterprises (including faculty salaries) but also a large portion of research and education costs. Loss of 340b pharmacy income, the more government payers, CMS regulations and potential penalties, and narrowing clinical networks all have reduced revenue for many AMCs. Adding these proposed rule changes will send many AMCs further into negative margins: This will affect the training of our next-generation leaders and discoveries of new science.
John I. Allen, MD, MBA, AGAF, professor of medicine, division of gastroenterology, University of Michigan School of Medicine, Ann Arbor. He reported no conflicts.
On July 12, 2018, CMS published a set of “proposed rules” that will have substantial impact on your practice. CMS released a 665-page document with 26 proposed changes in Medicare. A public comment period is open until Sept. 10, 2018. Final rules will be published in the fall with implementation expected in January 2019.
Medicare proposes to reduce the number of E/M coding levels to two (from five: these relate to current CPT codes 99201-99205 and 99211-99215), with documentation requirements reduced to those required for current level 2. If you tend to bill levels 4-5, your bottom line will be affected.
CMS wants to eliminate site-of-service differences in both clinic and ASC payments. This will modify the financial advantages gained by practices who sold their centers to hospital systems and for health systems that have HOPD endoscopy centers and clinics.
Endoscopy with biopsy and colonoscopy with polypectomy were again identified as being potentially overvalued and thus may trigger a re-analysis.
A policy change announced recently by CMS would allow Medicare Advantage plans to establish sequence requirements (step therapy) for medical therapies, including biologics.
While community practices clearly will be affected by these changes, the financial pressures on academic medical centers will be immense. AMC’s have high fixed costs and deteriorating clinical margins. Clinical revenue supports not only clinical enterprises (including faculty salaries) but also a large portion of research and education costs. Loss of 340b pharmacy income, the more government payers, CMS regulations and potential penalties, and narrowing clinical networks all have reduced revenue for many AMCs. Adding these proposed rule changes will send many AMCs further into negative margins: This will affect the training of our next-generation leaders and discoveries of new science.
John I. Allen, MD, MBA, AGAF, professor of medicine, division of gastroenterology, University of Michigan School of Medicine, Ann Arbor. He reported no conflicts.
On July 12, 2018, CMS published a set of “proposed rules” that will have substantial impact on your practice. CMS released a 665-page document with 26 proposed changes in Medicare. A public comment period is open until Sept. 10, 2018. Final rules will be published in the fall with implementation expected in January 2019.
Medicare proposes to reduce the number of E/M coding levels to two (from five: these relate to current CPT codes 99201-99205 and 99211-99215), with documentation requirements reduced to those required for current level 2. If you tend to bill levels 4-5, your bottom line will be affected.
CMS wants to eliminate site-of-service differences in both clinic and ASC payments. This will modify the financial advantages gained by practices who sold their centers to hospital systems and for health systems that have HOPD endoscopy centers and clinics.
Endoscopy with biopsy and colonoscopy with polypectomy were again identified as being potentially overvalued and thus may trigger a re-analysis.
A policy change announced recently by CMS would allow Medicare Advantage plans to establish sequence requirements (step therapy) for medical therapies, including biologics.
While community practices clearly will be affected by these changes, the financial pressures on academic medical centers will be immense. AMC’s have high fixed costs and deteriorating clinical margins. Clinical revenue supports not only clinical enterprises (including faculty salaries) but also a large portion of research and education costs. Loss of 340b pharmacy income, the more government payers, CMS regulations and potential penalties, and narrowing clinical networks all have reduced revenue for many AMCs. Adding these proposed rule changes will send many AMCs further into negative margins: This will affect the training of our next-generation leaders and discoveries of new science.
John I. Allen, MD, MBA, AGAF, professor of medicine, division of gastroenterology, University of Michigan School of Medicine, Ann Arbor. He reported no conflicts.
Citing the need to reduce paperwork hassles, officials at the Centers for Medicare & Medicaid Services are proposing to flatten the payment for evaluation and management (E/M) visits coded at levels 2-5.
The CMS outlined how the proposal would affect payment using 2018 rates to model the change. The proposal would set the payment rate for level 1 E/M office visits for new patients at $44, down from the $45 using the current methodology. Levels 2-5 would receive $135. Currently, payments for level 2 visits are set at $76, level 3 at $110, level 4 at $167, and level 5 at $211.
For office visits with established patients, the proposed rate would be $24, up from the current payment of $22 for a level 1 visit. Levels 2-5 would receive $93. Under the current methodology, payments for level 2 visits are set at $45, level 3 at $74, level 4 at $109, and level 5 at $148.
The change also comes with a reduced documentation burden, so the same documentation is needed regardless of which level between 2 and 5 the office visit is, a move that is expected to save time.
The CMS outlined its vision for changes to the E/M payment in the proposed update to the 2019 Medicare physician fee schedule. Comments on the proposal are due Sept. 10, 2018.
The agency estimated that for most specialties, there would be minimal effect on this proposed change. However, for 10 specialties, payment reductions could result from this change. The proposal is raising concerns, particularly from those who stand to see their pay reduced.
CMS officials estimate the proposal would save time. CMS Administrator Seema Verma said that the documentation change would result in an additional 51 hours for patient care per clinician per year.
“The agency has clearly heard from physicians about the need to reduce administrative burdens for physicians,” stated Lisa Gangarosa, MD, AGAF, chair, AGA Government Affairs Committee. “In that regard, CMS should be commended. Unfortunately, in their efforts to reduce burden, CMS has proposed changes that drastically undervalue the care gastroenterologists and hepatologists provide to patients with inflammatory bowel disease, motility disorders, chronic liver disease and other complex gastrointestinal diseases.”
Angus B. Worthing, MD, chair of the American College of Rheumatology’s Committee on Government Affairs, said he was doubtful that any increase in volume would offset the losses from the proposed flat payment across levels 2-5 E/M visits, especially if the pay decrease results in access issues.
SOURCE: CMS proposed rule, CMS-1693-P.
Citing the need to reduce paperwork hassles, officials at the Centers for Medicare & Medicaid Services are proposing to flatten the payment for evaluation and management (E/M) visits coded at levels 2-5.
The CMS outlined how the proposal would affect payment using 2018 rates to model the change. The proposal would set the payment rate for level 1 E/M office visits for new patients at $44, down from the $45 using the current methodology. Levels 2-5 would receive $135. Currently, payments for level 2 visits are set at $76, level 3 at $110, level 4 at $167, and level 5 at $211.
For office visits with established patients, the proposed rate would be $24, up from the current payment of $22 for a level 1 visit. Levels 2-5 would receive $93. Under the current methodology, payments for level 2 visits are set at $45, level 3 at $74, level 4 at $109, and level 5 at $148.
The change also comes with a reduced documentation burden, so the same documentation is needed regardless of which level between 2 and 5 the office visit is, a move that is expected to save time.
The CMS outlined its vision for changes to the E/M payment in the proposed update to the 2019 Medicare physician fee schedule. Comments on the proposal are due Sept. 10, 2018.
The agency estimated that for most specialties, there would be minimal effect on this proposed change. However, for 10 specialties, payment reductions could result from this change. The proposal is raising concerns, particularly from those who stand to see their pay reduced.
CMS officials estimate the proposal would save time. CMS Administrator Seema Verma said that the documentation change would result in an additional 51 hours for patient care per clinician per year.
“The agency has clearly heard from physicians about the need to reduce administrative burdens for physicians,” stated Lisa Gangarosa, MD, AGAF, chair, AGA Government Affairs Committee. “In that regard, CMS should be commended. Unfortunately, in their efforts to reduce burden, CMS has proposed changes that drastically undervalue the care gastroenterologists and hepatologists provide to patients with inflammatory bowel disease, motility disorders, chronic liver disease and other complex gastrointestinal diseases.”
Angus B. Worthing, MD, chair of the American College of Rheumatology’s Committee on Government Affairs, said he was doubtful that any increase in volume would offset the losses from the proposed flat payment across levels 2-5 E/M visits, especially if the pay decrease results in access issues.
SOURCE: CMS proposed rule, CMS-1693-P.