Medicare payment news for 2018: the key takeaways

As 2017 draws to a close, the Medicare program is notifying physicians how they will be evaluated and paid for treating patients in 2018. In case you’re not an avid reader of the Federal Register (and most people aren’t), let’s go over some details.

First, the Centers for Medicare & Medicaid Services (CMS) released its final rule on the 2018 Quality Payment Program. Highlights:

• Your cost performance will now make up 10 percent of your final score under the Merit-based Incentive Payment System (MIPS) while your quality performance’s share will decrease to 50 percent.
• You must now report your quality measures for a full year, not just 90 days.
• The MIPS performance threshold, below which you would receive a negative payment adjustment, increases from three points to 15 points.
• Medicare will add up to 5 bonus points to your final MIPS score if you treat complex patients and 5 bonus points if you are in a small practice.
• “Virtual groups” will now be an option for you to participate in MIPS.
• The “low volume threshold” for determining if an eligible physician or group must participate in MIPS will increase to either $90,000 in Part B allowed charges or 200 Medicare Part B beneficiaries; if you are otherwise eligible but at or below either of these threshold numbers, you are excluded from MIPS.

CMS has provided an overview and an executive summary of the final rule, which is open for comments until Jan. 2.  For more information about the Quality Payment Program, please visit: qpp.cms.gov.

In addition, CMS released the final rule on the 2018 Medicare physician fee schedule. As usual, the final rule includes the relative values physicians will be paid under the fee schedule next year for individual services as well as updates the conversion factor, or the dollar multiplier that translates those relative values into actual payment allowances. The final rule raises the 2018 conversion factor by a dime to $35.99.

Other aspects of the fee schedule final rule include:

• Reducing the payment rates for certain items and services furnished by certain off-campus hospital outpatient provider-based departments from 50 percent of the outpatient prospective payment system (OPPS) rate to 40 percent.
• Adding several codes to the list of covered telehealth services and eliminating the required reporting of the telehealth modifier GT for professional claims.
• Adopting CPT codes to report several care management services currently reported using Medicare G-codes.
• Finalizing certain Level II HCPCS modifiers to be used on claims to indicate patient relationship categories. Reporting of these HCPCS modifiers is voluntary beginning Jan. 1.

Lastly, the final rule on the physician fee schedule implements the expanded model of the Medicare Diabetes Prevention Program (MDPP). This includes additional policies necessary for suppliers to begin furnishing MDPP services nationally in 2018, such as the MDPP payment structure, supplier enrollment requirements, and supplier compliance standards meant to enhance program integrity.

More information on the physician fee schedule final rule is available on the CMS website.

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