AAFP Summarizes 2018 Medicare Physician Fee Schedule

Final Rule Changes Value-based Payment Modifier, Physician Feedback Program

November 20, 2017 02:03 pm News Staff

Understanding that few family physicians have time to review the entire 396-page 2018 final Medicare physician fee schedule that was released by CMS on Nov. 2 and published in the Nov. 15 Federal Register,(www.gpo.gov)  the AAFP has posted a four-page executive summary(4 page PDF) to highlight the information most useful to members.

[Magnifying glass enlarging the word Review on parchment background]

The following is a snapshot of that summary.

Key Provisions Summarized

The summary points out a slight increase of 0.3 percent in the 2018 conversion factor, bringing it to $35.999 for the coming year.

However, the AAFP notes that "since CMS was not able to fully meet the misvalued code target required by law, physicians will not receive the full positive 0.5 percent update in 2018 called for in the Medicare Access and CHIP Reauthorization Act (MACRA)."

Review the table on page four of the summary to see the estimated impact on total allowed charges by specialty for 2018.

In an effort to "better align incentives and provide a smoother transition" to the Merit-based Incentive Payment System, CMS made changes to the value-based payment modifier and its physician feedback program.

Specifically, the final rule

  • reduces the downward payment adjustment physicians will receive for not meeting Physician Quality Reporting System (PQRS) criteria to -2 percent (from -4 percent) for groups of 10 or more clinicians, and to -1 percent (from -2 percent) for solo physicians and groups of two to nine clinicians,
  • holds harmless from downward payment adjustments all physician groups and solo physicians who met the criteria to avoid the negative PQRS adjustment for performance under "quality-tiering" for the last year of the program, and
  • aligns the maximum positive adjustment to two times the adjustment factor for all physicians.

Regarding appropriate use criteria (AUC) for advanced diagnostic imaging services, CMS will begin the AUC program with an "educational and operations testing year in 2020." A voluntary physician participation period will run from mid-2018 through 2019.

On the issue of care coordination services in rural health centers (RHCs) and federally qualified health centers (FQHCs), the final rule states that beginning Jan. 1, 2018, both RHCs and FQHCs will be paid for providing chronic care management services, general behavioral health integration and care under the psychiatric collaborative care model.

Two new billing codes were "created exclusively" for RHC and FQHC payment, notes the AAFP. Furthermore, such payment would be "in addition to the payment for an RHC or FQHC visit."

Regarding patient relationship categories and codes under MACRA, CMS finalized some Healthcare Common Procedure Coding System (HCPCS) modifiers to indicate patient relationship categories on claims and finalized policy that makes physician reporting of these HCPCS modifiers voluntary as of Jan. 1, 2018.

The Medicare Diabetes Prevention Program (MDPP) -- strongly supported by the AAFP -- is addressed in the final rule with the addition of policies "necessary for suppliers to begin furnishing MDPP services nationally in 2018," says the summary.

Those policies include the MDPP payment structure, supplier enrollment requirements and supplier compliance standards.

When commenting on the proposed rule in late summer, the AAFP urged CMS to "work with speed and efficiency to make these services available on Jan. 1, 2018."

Additional Issues Important to FPs

Other issues covered by the final rule include

  • establishment of payment rates for nonexcepted items and services furnished by nonexcepted off-campus provider-based hospital departments,
  • finalization of a retroactive change to the current PQRS program policy that reduces the reporting requirement from nine measures to six,
  • changes to the clinical quality measure reporting requirements under the Medicare Electronic Health Records Incentive Program related to reporting through the PQRS portal, and
  • finalization of new policies for the Medicare Shared Savings Program.

More From AAFP
AAFP comment letter on 2018 proposed rule(40 page PDF)

Additional Resource
CMS Fact Sheet: 2018 Medicare Physician Fee Schedule(www.cms.gov)