Reimbursement

2019 Medicare Physician Payment Policies Final

November 6, 2018

 

Final 2019 Medicare payment policies for physicians will promote new access to virtual care via telehealth, remote patient monitoring, and other communication technology-based services. These and other policy changes were included a final regulation from the Centers for Medicare & Medicaid Services (CMS) that sets payment policies and rates for physician services during Calendar Year 2019.

Highlights:
 

Telehealth:  CMS finalized a range of proposals that will:
 

  • Cover telehealth technologies used for prolonged preventive services that go beyond just the service time of the primary procedure. 
  • Cover two newly defined physician services provided via telecommunications technology: a virtual check-in to decide whether an office visit is needed; and remote evaluation of patient-transmitted video or images to determine whether a visit is needed.
  • Add the home of an individual as a permissible originating site for telehealth services for treating a substance use disorder.
  • Provide separate payment for new codes on remote patient monitoring for patients with chronic conditions and for internet consultation among clinicians.
  • Cover telehealth services, without geographic restrictions, for the monthly clinical assessments of end-stage renal disease (ESRD) patients receiving dialysis in their homes or in dialysis facilities.
  • Add mobile stroke units as originating sites and not apply geographic requirements to diagnosing, evaluating, or treating symptoms of acute stroke.
  • Provide payment for rural health clinics and federally qualified health centers for communications-technology based services and remote evaluation even when there is no associated clinical visit.
     

Appropriate Use Criteria (AUC): CMS will include independent diagnostic testing facilities (IDTFs) in the definition of applicable settings in which physicians are required to consult appropriate use criteria when they use advanced diagnostic imaging. Existing applicable settings include physician offices, hospital outpatient departments, and ambulatory surgical centers. CMS is also allowing AUC consultations, when not personally performed by the ordering professional, to be performed by clinical staff under the direction of the ordering professional.
 

Quality Payment Program: In the Merit-based Incentive Payment System (MIPS), which uses physicians’ performance to determine if they qualify for incentive payments, CMS will remove process-based quality measures that clinicians have said are low-value. The agency says this will allow clinicians to focus on measures that have a greater impact on health outcomes. Also, in determining physician performance in 2019 for the MIPS category that focuses on meaningful use of certified EHR technology, the agency will require physicians to use the 2015 Edition certified EHR technology.
 

Site Neutral Payments: Payments for procedures done in certain off-campus hospital outpatient provider-based facilities will be set at 40% of what would have been paid under the Medicare hospital outpatient department payment rate. This is the same payment level as in 2018. 


Radiologist Assistants: CMS will provide greater practice flexibility for radiology assistants by allowing those meeting certain requirements to perform diagnostic tests under the direct supervision of a physician, rather than under the personal supervision of the physician, to the extent allowed by states.

Evaluation and Management: CMS is simplifying and streamlining documentation requirements that physicians must meet for evaluation and management visits.