Radiologists, rejoice: An analysis by the American College of Radiology (ACR) of the final rule implementing the 2019 Medicare Physician Fee Schedule (MPFS) found no major surprises for radiology. It's not a bad outcome for the coming year, the ACR said in a statement.
On November 1, the U.S. Centers for Medicare and Medicaid Services (CMS) released the MPFS final rule that left reimbursements stable, with no effect on radiology, cuts of 1% to nuclear medicine and radiation oncology/radiation therapy centers, and a payment increase of 2% for interventional radiology.
"Upon initial review, the ACR is pleased with several of the payment provisions within this rule," the college said.
Acting on the AUC
The rule finalizes the agency's plan to move forward with appropriate use criteria (AUC) and clinical decision support (CDS) for diagnostic imaging services on January 1, 2020. This date will kick off a one-year testing period for the program, and CMS plans to use a series of G-codes and modifiers -- which will be specified in the 2020 MPFS rule-making process -- as the programs are implemented.
"During the [testing] period, ordering professionals will consult AUC and furnishing providers will report AUC consultation information on the claim, but CMS will continue to pay claims whether or not the correct information is included," the ACR said. "The agency notes that this educational period will allow professionals to actively participate in the program while avoiding claims denials during the learning curve."
Payments to off-campus providers
The rule finalizes CMS' response to the Bipartisan Budget Act of 2015, legislation which mandated that certain items or services provided by off-campus hospital outpatient departments no longer be paid under the Hospital Outpatient Prospective Payment System (HOPPS). In 2018, CMS began paying for these services under the MPFS at 40% of the HOPPS rate, and this will continue in 2019, according to the rule.
Easing E/M
The agency has decided to reduce documentation requirements for evaluation and management (E/M) services. CMS has delayed until 2021 its proposed single-payment policy for office and outpatient E/M visits at levels 2 to 5 (2 = patient's problem is of low to moderate severity; 3 = problem is of moderate severity; 4 = problem is of moderate to high severity, physician spends 45 minutes with patient; and 5 = problem is of moderate to high severity, physician spends 60 minutes with patient). In 2021, the agency will consolidate reimbursement for E/M visits levels 2 to 4, while keeping a separate payment rate for level 5 visits.
Quality care
In this final rule, CMS has also changed how it will weigh various measures required for implementation of its Merit-Based Incentive Payment System (MIPS) for Advanced Alternative Payment Models (APMs). The cost category will be weighted at 15%, while the quality category will be weighted at 45%; interoperability and improvement activities will be weighted at 25% and 15%, the ACR said.
Comments to come
The ACR plans to conduct a detailed review of the final MPFS 2019 rule in the coming weeks and submit comments by the December 31 deadline set by CMS, it said.
