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What is the impact of the CMS proposed changes to the physician fee schedule for 2019?

On July 12, 2018, the Centers for Medicare and Medicaid (CMS) released its proposal for 2019 changes to the physician fee schedule. This is an update on policies and rates for physician and other health care professions under Medicare.

There are several proposed changes to the Evaluation and Management (E/M) codes to improve coding and payments for office and outpatient visits to medical providers. The current system of determining the appropriate code, and therefore payment, has relied upon a complex mixture of documentation of medical history, review of systems, past family and social history, the examination, and medical decision making.

The proposal will allow practitioners to focus on the current problems rather than re-documenting the past history and extensive exam. As well, it will allow practitioners to review and verify the information that has been inputted by ancillary staff rather than re-entering the information.

The proposal allows coding to be based more on medical decision-making or on the time it takes for the visit rather than the re-documentation of history and full examination. There is a proposed new, single blending payment rate for new patients with level 2 thru 5 visits, and some add-on codes to reflect any resources involved with the care and services.

CMS states it believes the proposals will allow practitioners more flexibility to exercise clinical judgment in documentation so the focus is placed on what is clinically relevant and medically necessary for the patient.

Reference: https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-3