November 2018

On November 1, 2018, the Centers for Medicare & Medicaid Services (“CMS”) released an advanced copy of the final rule announcing policies and payment levels for the Medicare Physician Fee Schedule for 2019, implementing policy changes to the Quality Payment Program (“QPP”), and announcing other miscellaneous payment policies for Medicare Part B items and services.  The final rule is scheduled to be published in the Federal Register on November 23, 2018 and CMS will accept comments from stakeholders through December 31, 2018.

The final rule implements policies that are aimed at continuing overarching efforts by CMS to reduce regulatory burdens on providers, expand the availability of remote care and telehealth services, address concerns about the high cost of prescription drugs and promote value based care.  Although the final rule contains provisions addressing a variety of payment changes, this alert addresses those of broadest applicability to health care providers:

  • Changes in the Documentation, Payment and Coding of Evaluation and Management Visits for the Office and Outpatient Setting 
  • Expansion of Medicare Coverage for Communication Technology-Based Services and Telehealth Services
  • Conversion Factor and Implementation of Updated Market-Based Supply and Equipment  Pricing 
  • Reduction in the Add-On Payment for Part B Drugs Paid Based on Wholesale Acquisition Cost 
  • 2019 Payment Rates for Nonexcepted Items and Services Delivered by Nonexcepted Off-Campus Provider-Based Hospital Outpatient Departments
  • Implementation and Request for Comment on New Opioid Treatment Program Medicare Benefit Category
  • Technical Revisions to the Physician Self-Referral Law
  • Amendments to the Quality Payment Program for Performance Year 2019

View the full alert here.