CMS Final Rule 2019

November sees the publishing of Medicare’s final rules for 2019. It has allowed for sweeping changes to Telehealth, provider reimbursement and Quality reporting.

Medicare will now reimburse for patients connecting with their provider in a telecommute session to determine if an in-office visit is necessary.

Changes made to the Quality Payment Program (QPP) will shift the focus from paperwork to positively impacting health outcomes. The key focus is on sharing information between providers electronically. The Promoting Interoperability category of MIPS will support increased EHR interoperability. The focus of this change is to encourage doctors to update their EHRs for better cross-provider communication. The question that remains to be answered is if EHR vendors can meet the needs of providers to help them meet this measure.

Regarding the proposed changes in E&M coding, the paperwork reduction has still gone through. However, after fielding comments and concerns from the provider community, CMS will continue to reimburse for Level 5 visits separately, as they require the most complex evaluation of care, however, this would not go into effect until 2021. As for the changes to documentation requirements, the biggest change revolves around established patients. For established patient visits, providers will be able to focus on what has changed since the last visit, or relevant items that have not, so long as it is noted that the provider reviewed the previously documented histories, meds and allergies.

Likewise, they have opted to delay further changes to E&M coding to 2021 to provide more opportunities for provider engagement. “Physicians will see some immediate changes in 2019 that reduce burden and ever more significant burden reduction in 2021, when broader changes to the E&M framework take effect,” Seema Verma, CMS administrator, said.

Lastly, CMS has announced effective January 1, 2019, reduced payment amounts for new drugs under Part B.

What do you think about the Final Rule? Is your practice ready for interoperability? Is your EHR vendor?