Medicare Strikes Again!


We all know Medicare likes to keep things simple and easy to
navigate. Yeah right. Medicare is about as simple as making your way through a
moving labyrinth while blindfolded and balancing on a high wire. But don’t get
upset or depressed, MPS is here to help!

Here at MPS, we want to guide you through the new 2019
Medicare Physician Fee Schedule Proposed Rule. It’s our job to understand all
the twists and turns for you so that you can do your job in helping the
community be healthy and happy.


Let’s start with the good news. The proposal estimates a
higher conversion factor of $36.0463 as well as estimates of $22.2986 for
anesthesia. Also, these proposed changes are aimed at the Centers for Medicare
and Medicaid Services (CMS) goal of Patients Over Paperwork. Patients Over
Paperwork is designed to decrease the red tape so providers can spend more time
with their patients. Change isn’t always negative, even with Medicare! From
here on out, it is up for debate on how good or bad the proposed changes are.


Another proposed change is the documentation requirements
and payments for E/M visits. These proposed changes apply to office/outpatient
codes 99201-99215. Medicare would like to simplify History and Exam
documentation requirements for established patients. This means that if the
rule is adopted you would only be required to document what has changed since
the last visit or pertinent items that have not changed. You might not have to
re-enter information that has already been entered by ancillary staff members
for new and established patients.

One of the reasons Medicare is proposing to no longer require
you to re-enter the History and Exam documentation is because they propose to
no longer use History and Exam to determine E/M service levels. They want to
only use medical decision-making (MDM) as the sole determinant of E/M service


Medicare is trying to make it easier for providers to comply
with either their Merit-based Incentive Payment System (MIPS) or the Medicare
Access and CHIP Reauthorization Act (MACRA) by changing the quality measures. Proposed
changes with qualifying for MIPS includes a dollar amount of $90,000 of allowed
charges, serving at least 200 beneficiaries and with a variety of at least 200 professional

CMS is proposing to reduce bonus money for the physicians in
these programs. It is estimated that in 2019 there will be up to $833 million
in MIPS incentives for eligible doctors. With the reductions, the estimates for
2020 are closer to only $118 million.


Clinicians now may be eligible for virtual check-ins which
consist of brief, non-face-to-face appointments via communications technology
which includes evaluating patient-submitted photos. CMS even wants to include
prolonged preventive care for telehealth services. CMS anticipates the rise in
technology and knows sometimes a provider may help a patient via communication
technology and never have an actual office visit.


Don’t be stressed wasting your precious time studying all
the Medicare laws every time something changes. Contact us and we’ll guide you
through and help you become a successful practice that can focus more on their
patients and less on the labyrinth that is Medicare.