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December 2018 Client Newsletter

2019 Medicare Deductible
The Part B deductible increases slightly to $185.

CMS - Final 2019 Payment and Quality Reporting Changes
On November 1st, the Centers for Medicare & Medicaid Services (CMS) released the final 2019 Physician Fee Schedule (PFS), which includes payment updates and modifications to the Merit-based Incentive Payment System (MIPS) reporting requirements and alternative payment model (APM) participation options starting Jan. 1, 2019. The final rule includes the following key changes:  
  • Sets the CY 2019 PFS conversion factor at $36.0391. The CY 2019 national average anesthesia conversion factor will be $22.2730.
  • Makes changes to E/M payment rates starting in CY 2021 by collapsing E/M office visit levels 2 through 4 for established and new patients, while maintaining a separate payment for level 5 visits.
  • Creates new covered codes for technology-based services, including virtual care and remote patient monitoring codes.
  • Outlines changes to MIPS reporting requirements, including a requirement for clinicians and practices to adopt 2015 edition Certified EHR Technology for Promoting Interoperability reporting.
  • After consideration of concerns raised by commenters in response to the proposed rule, CMS is not finalizing aspects of the proposal that would have: (1) reduced payment when E/M office/outpatient visits are furnished on the same day as procedures, (2) established separate coding and payment for podiatric E/M visits, or (3) standardized the allocation of practice expense RVUs for the codes that describe these service.
  • For Physical Therapy, functional status reporting will be discontinued after December 31, 2018.
  • Payment Rates for Non-excepted Off-campus Provider-Based Hospital Departments Paid Under the PFS will be significantly decreased to 40% of the Outpatient Prospective Payment System (OPPS) to encourage fairer competition between hospitals and physician practices by promoting payment alignment between outpatient settings.
For more information, you can review the physician payment fact sheet and QPP fact sheet associated with the 2019 final PFS. MGMA will analyze the final rule and provide a detailed analysis as a member benefit.
AmeriHealth Multiple Procedure Payment Reduction Policy and Payment Adjustments
AmeriHealth is updating its Multiple Procedure Payment Reduction Policy (MPPR) for certain diagnostic services, retroactive to January 1, 2017. AmeriHealth was originally unable to implement the MPPR policy change due to system limitations. As a result, some providers were overpaid and others underpaid. AmeriHealth will be reprocessing claims to accurately reflect the policy. If you are interested in the details, read more here. Physicians who were underpaid should receive applicable interest. Those who were underpaid are somewhat protected by NJ law which limits takebacks to 18 months after the date paid. Another time when due to the errors by an insurer the providers are punished.
Effective January 2019: AmeriHealth Requiring EFT
Effective January 1, 2019 AmeriHealth will require participating providers to receive payments via electronic funds transfer.
Effective January 2019: UHC Retiring Prior Authorization Fax Numbers
United Healthcare is promoting electronic prior authorization through its online application. As a result, UHC will retire the following fax numbers effective January 1, 2019: 877-269-1045, 866-362-6101, 866-892-4582, 866-589-4848, 866-255-0959.
Due December 31: QPP Exception Applications
CMS is now accepting Quality Payment Program exception applications (click the link to go to the application) for the Promoting Interoperability performance category and Extreme and Uncontrollable Circumstances for MIPS. Applications are due December 31.
CMS Releases Procedure Price Lookup Tool
As required in the 21st Century Cures Act, CMS recently released the Procedure Price Lookup Tool which allows consumers to compare Medicare procedure costs across different clinical settings. The tool reveals national averages for what Medicare pays for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers, along with the national average copayment amount a beneficiary with no supplemental insurance would pay the provider.   
2018 Client Newsletter Archive