CMS releases physician payment proposals for 2018

The Centers for Medicare & Medicaid Services (CMS) this week released its proposed rules on the 2018 Medicare physician fee schedule (PFS). The proposal would increase overall rates in 2018 by 0.31 percent, effectively increasing the PFS conversion factor by a dime to $35.99.

Among the many proposals that are highlighted in a fact sheet on the proposed rule and on which CMS is seeking comments, the proposed rule would:

• No longer require physicians report the telehealth modifier for professional claims, which would reduce administrative burdens.
• Adopt CPT codes in 2018 for reporting several care management services currently reported using Medicare G-codes.
• Require physicians to begin using and reporting on their claims the Medicare Appropriate Use Criteria (AUC) for advanced diagnostic imaging. There would be an educational and operations testing year in 2019, meaning that CMS would continue to pay claims for advanced diagnostic imaging services regardless of whether they contain information on the required AUC consultation.
• Implement in 2018 the Medicare Diabetes Prevention Program expanded model.
• Use Level II HCPCS modifiers on claims to indicate patient relationship categories on a voluntary basis beginning Jan. 1.

Also, CMS is seeking recommendations on updating the documentation guidelines for evaluation and management (E/M) services to reduce the associated burden and better align E/M coding and documentation with the current practice of medicine. CMS is especially focused on the documentation guidelines for history and exam, which CMS believes may be more significantly outdated.

In addition to the payment and policy proposals, CMS is releasing a Request for Information (RFI) for other proposals to improve transparency, flexibility, program simplification, and innovation. These answers will guide future regulatory action related to the PFS.

Comments are due to CMS by Sept. 11.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians