Overview of Proposed Rule

The 2019 physician fee schedule proposed rule was released by CMS claiming historic changes that would increase the time that providers spend with patients and reduce the burden of paperwork. It has set off a wave of comments, many centered around the changes to E/M services. The changes to E/M are summarized as follows:


•Collapsing payment rates for E/M level 2 thru 5 visits into one payment rate:

  • New patients: $135

  • Established patients: $93

  • Proposed that certain specialties be allowed to bill add on codes in addition to E/M to adequately reflect resources utilized.

•Four ways to document, allowing providers to choose the method that works best for them:

  • Medical Decision making

  • Use time as driving factor, regardless of whether counseling or coordination of care dominates the visit

  • Use 1995 Documentation guidelines

  • Use 1997 Documentation guidelines.

  • Reduction of E/M service by 50% for visits billed with modifier 25 (procedure done on the same day)

•Reduction of E/M service by 50% for visits billed with modifier 25 (procedure done on the same day)


Although these E/M proposed changes reduce the documentation burden for providers, many believe that they will increase legal risk due to inadequate documentation and that they penalize providers that see complicated patients.


Some other key takeaways from the proposed rule are:


  • Payment for technology based services for remote provider-patient check-ins and remote evaluation of videos or images

  • Payment for remote physiologic monitoring of chronic care patients.

  • Payment for inter-professional internet consultations

  • Revision of supervision requirement for Radiology Assistants (RA) which would allow Radiologists to make full use of their RAs

  • Discontinuing the use of functional status reporting requirements for PT/OT

  • Addition of codes to support prolonged telehealth preventive services

  • Reduction of WAC based payments for new Part B drugs from WAC plus 6% to WAC plus 3%

  • Update of PFS conversion factor to $36.05 ($35.99 in 2018)

Comments on the proposed rule were due by September 10th and many organizations have issued statements on the potential impact of the proposed rule. The final rule is due to be released in October or November. It will be interesting to see how much of the proposed rule will pass. Fasten your seat belts for quick changes and education. We are always here to help


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