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MEDICARE FINAL POLICY, PAYMENT AND QUALITY PROVISIONS FOR 2019

On November 1st, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019. The list of main points:

  • Streamlining Evaluation and Management Payment and Reducing Clinician Burden
  • Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services
  • Comment Solicitation on Creating a Bundled Episode of Care for Management and Counseling Treatment for Substance Use Disorders
  • Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder and Other Substance Use Disorder
  • Providing Practice Flexibility for Radiologist Assistants
  • Discontinue Functional Status Reporting Requirements for Outpatient Therapy
  • Outpatient Physical Therapy and Occupational Therapy Services Furnished by Therapy Assistants
  • Medicare Telehealth Services
  • Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging
Now, let’s look over these points
Streamlining Evaluation and Management Payment and Reducing Clinician Burden

For CYs 2019 and 2020, several documentation policies will be implemented to provide immediate burden reduction, while other changes to documentation, coding, and payment would be implemented in CY 2021.

Discontinue Functional Status Reporting Requirements for Outpatient Therapy

Proposed rule is to discontinue Functional Status reporting requirements effective January 1st, 2019. The data from the functional reporting system was MEDICARE FINAL POLICY, PAYMENT AND QUALITY PROVISIONS FOR 2019 14 to be used to aid CMS in recommending changes and reforming of Medicare payment for outpatient therapy services that were subject to the statutory therapy caps. Proposed rule is to discontinue the functional status reporting requirements for services furnished on or after January 1, 2019

Outpatient Physical Therapy and Occupational Therapy Services Furnished by Therapy Assistants

The Bipartisan Budget Act of 2018 requires payment for services furnished in whole or in part by a therapy assistant at 85 percent of the applicable Part B payment amount for the service effective January 1, 2022. New modifiers will be established to implement these changes. The new therapy modifiers for services furnished by PTAs and OTAs are not required on claims until January 1, 2020.

Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services

Two newly defined physicians’ services furnished using communication technology will be paid separately:

  • Brief communication technology-based service, e.g. virtual check-in (HCPCS code G2012) and
  • Remote evaluation of recorded video and/or images submitted by an established patient (HCPCS code G2010) Also chronic care remote physiologic monitoring (CPT codes 99453, 99454, and 99457) and interprofessional internet consultation (CPT codes 99451, 99452, 99446, 99447, 99448, and 99449) will be paid separately.
Comment Solicitation on Creating a Bundled Episode of Care for Management and Counseling Treatment for Substance Use Disorders Disorders

Before creating new guidelines or rules regarding management and counseling treatment for substance abuse disorders and prevention of opioid use disorder, improving access to treatment, CMS invited specialist to share their comments. CMS received many comments on these solicitations with detailed information to help in future rulemaking.

Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder and Other Substance Use Disorders

Through an interim final rule with comment period, CMS is implementing a provision from the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act that removes the originating site geographic requirements and adds the home of an individual as a permissible originating site for telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder for services furnished on or after July 1, 2019.

Providing Practice Flexibility for Radiologist Assistants

СMS is revising the physician supervision requirements so that diagnostic tests performed by a Radiologist Assistant (RA) that meets certain requirements, that would otherwise require a personal level of physician supervision, may be furnished under a direct level of physician supervision to the extent permitted by state law and state scope of practice regulations.

Medicare Telehealth Services

For CY 2019 2 HCPCS codes are added to the list of telehealth service:

- G0513 and G0514 (Prolonged preventive services)

CMS is also finalizing policies to add mobile stroke units as originating sites. Originating site type or geographic requirements will not apply for telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke

Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging

For CY 2019, CMS is finalizing the revision of the significant hardship criteria in the Appropriate Use Criteria program to include: 1) insufficient internet access; 2) electronic health record (EHR) or clinical decision support mechanism (CDSM) vendor issues; or 3) extreme and uncontrollable circumstances.

Full text is here.

Insights
November 2018