The Medicare Physician Fee Schedule (PFS), which pays providers through the Quality Payment Program (QPP), would allow more types of clinicians to participate in the Merit-based Incentive Payment System (MIPS), advance virtual care, and streamline and reduce reporting requirements for 2019. In an advance release of the Proposed rule affecting the PFS, Medicare Part B, the Medicare Shared Savings Program (MSSP), and the QPP, CMS suggested policies intended to save clinicians’ time and administrative costs by reducing what the agency called unnecessary paperwork requirements. The Proposed rule also implements parts of the Bipartisan Budget Act of 2018 (BBA) (P.L. 115-123), and will publish in the Federal Register on July 27, 2018; to ensure consideration, comments on the proposals must be received by September 10.
QPP Year 3. 2019 will be the third year of the QPP, which was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10). For year 3, CMS proposed a number of changes to the QPP:
- More provider types in MIPS. The Proposed rule would include four additional clinician types—physical therapists, occupational therapists, clinical social workers, and clinical psychologists—to the list of MIPS-eligible clinicians.
- Low-volume threshold. CMS proposed altering the low-volume threshold to add a third element. The threshold already had two criteria: dollar amount billed to Part B ($90,000) and number of Part B beneficiaries served (200). The new criterion would be the number of covered professional services (200). CMS also proposed allowing eligible clinicians and groups of clinicians to opt-in to MIPS if they meet or exceed one or two of the three criteria for the low-volume threshold.
- Performance categories. There are four performance categories for MIPS—quality, improvement activities, cost, and advancing care information. CMS is proposing to restructure the advancing care information category, including changing its name to promoting interoperability, and proposed adding new episode-based measures to the cost performance category.
- Alternative Payment Models (APMs). The Proposed rule would streamline requirements for Advanced APMs and increase flexibility to allow non-Medicare payers to participate in the QPP through Other Payer Advanced APMs and the All-Payer Combination Option. It would also update the certified electronic health record technology (CEHRT) threshold so that at least 75% of eligible clinicians in an Advanced APM Entity use CEHRT. Lastly, it would extend the 8 percent revenue-based nominal amount standard through performance year 2024.
CMS released a fact sheet on the Proposed rule with charts explaining the MIPS and Advanced APM policies for 2018 (year 2 of QPP, see Year 2 of Quality Payment Program speeds transition, eases burdens, November 16, 2017) and showing how they would change if the Proposed rule is finalized for year 3.
Conversion factor and other PFS proposals. For 2019, CMS estimates that the PFS conversion factor will be $36.05, up from the 2018 conversion factor of $35.99. The Proposed rule considers changes to relative value units (RVUs) including misvalued and potentially misvalued codes, as required by section 3143 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) and communication technology-based services. It proposes changes for evaluation and management (E/M) payments, particularly with regard to coding and documentation. It would also recognize communication technology-based services, including the virtual check-ins, remote evaluation of video of images submitted by a patient, and internet consultations. The agency proposed practice flexibility for radiologist assistants in accordance with state law and scope-of-practice rules.
CMS also announced the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration consider how MIPS-eligible physicians’ participation in payment arrangements with Medicare Advantage Organizations (MAO). For more information on the MAQI Demonstration, see CMS unveils new MAQI demonstration to test alternative to existing QPP requirements, in this issue.
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