Additional Proposed CY2019 CMS Changes

We have talked a lot over the last month or so about the proposed changes to E&M Coding and reimbursement. There are additional proposed changes we want to make sure you are aware of as well.

Advancing Virtual Care

CMS is building a stronger focus on remote or virtual care. Proposed changes would add reimbursement to providers for “virtual check-ins.” This is an audio or video meeting between the provider and the patient to determine if an in-office visit is necessary.

Providers would also be reimbursed for the evaluation of patient submitted photos. Also, telehealth would be expanded to include prolonged preventative services.

Lowering Drug Costs

This affects Medicare Part B. CMS is proposing a change in the payment amount for new drugs, such as infusions so that the payment amount would more closely match the actual cost of the drug. This will reduce the out of pocket costs for seniors, as well as the reimbursement to the provider for these new drugs.

Quality Payment Program Proposed Changes

The changes proposed to the QPP are meant to reduce clinician burden and focus on patient outcomes. Proposed changes include removing MIPS process-based quality measures that providers have agreed are either low value or low-priority.

There is also a proposed overhaul of the “Promoting Interoperability” performance category. This would increase the focus on EHR interoperability as well as patient access to their health information.

We will continue to review and keep abreast of proposed rules for 2019 to keep you up-to-date on finalized rules as they are published.


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