Issue link: https://beckershealthcare.uberflip.com/i/1043345
38 GI/ENDOSCOPY How the proposed 2019 Medicare Physician Fee Schedule can impact GIs — 12 insights By Eric Oliver T he American College of Gastroen- terology, American Gastroentero- logical Association and American Society of Gastrointestinal Endoscopy re- leased a joint address on CMS' 2019 Medi- care Physician Fee Schedule proposed rule. e rule has several significant policy and payment changes, as well as multiple pro- posals for year three of the Quality Pay- ment Program. e three organizations are evaluating the rules and plan to submit comments to CMS around Nov. 2. Here's what you should know: Medicare Physician Payment 1. CMS plans to increase the 2019 Pro- posed Conversion Factor 0.03 percent, from $35.99 to $36.05. 2. CMS proposed a new reimbursement methodology for evaluation and man- agement services. Under the proposals, a new patient level 2-5 and established patient level 2-5 would receive a blended payment. 3. CMS is also changing how physicians document office and outpatient evalua- tion and management visits. e proposed changes will allow physicians to cite time when selecting visit level and document- ing the visit focus in their documentation on what has changed or the pertinent items that have not changed. It will allow for medical records to be reviewed and verified instead of reentered. 4. CMS is also proposing several new GI codes as E/M add-on services. e public said two GI codes were potentially mis- valued. 45385 - Colonoscopy with lesion removal and 43239 - EGD biopsy single/ multiple were said to have a systematic overvaluation of work RVUs. e societies are working to ensure the GI codes will be properly valued. 5. CMS is also proposing a billing service for when providers check-in on patients or address concerns through the telephone or other telecommunication devices. Provid- ers could bill whenever remote evaluation is used to determine whether additional services are needed. Quality Payment Program 6. CMS made several proposals to the Quality Payment Program for 2019 as well: • Performance threshold would increase from 15 points to 30 points • Quality would decrease from 50 percent to 45 percent • Cost would increase from 10 percent to 15 percent • Merit-based Incentive Payment System would be adjusted from +/- 5 percent to +/- 7 percent • Improvement activities and advancing care/promoting interoperability would stay the same at 15 percent and 25 percent, respectively 7. To avoid a negative payment adjust- ment, providers must have a MIPS score equal to or greater than the performance score. e payments adjustments would be based on 2019 data and apply to pay- ments in 2021. 8. CMS is removing 34 quality measures including: QPP185 related to colonoscopy. n Elevating medicine through data insights. NDI is a non-disruptive, FREE program for outpatient surgical centers that provides real-time benchmarking for informed decision making. nebuladataintel.com/demo • 224-701-6046 Participation is free. Contact us today for a demo.