The National Association for Medical Direction of Respiratory Care

The Washington Watchline

The Proposed 2019 Medicare Physicians Fee Schedule

On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule for the 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP). The Agency has submitted a number of new proposals including a significant change in the way outpatient care is to be documented and compensated, adding new codes for services furnished using telemedicine, increasing the weight of the cost performance category in the merit based incentive payment system (MIPS)  to 15% and adding another category to the MIPS low volume threshold.

MedPAC Proposes a Major Change to Compensation for Home Ventilators

In its June 2018 report to Congress, the Medicare Advisory Payment Commission (MedPAC) takes on “Issues in Medicare’s Medical Device Payment Policies” with recommendations to change the way in which home ventilators are reimbursed by Medicare. Specifically, the Commission has recommended that compensation for home ventilators be transferred to the Competitive Bidding Program (CBP). The Medicare Modernization Act of 2003, the legislation that established the CBP, exempted certain items from inclusion in the program.

DME and the New CMS Provider Documentation Manual

The Centers for Medicare and Medicaid (CMS) Center for Program Integrity has recently announced a new project related to its oversight of the use of durable medical equipment (DME). The Center is creating a Provider Documentation Manual that is to be accessed on the CMS web site with the purpose of ensuring that orders for durable medical equipment meet all existing regulations.

The Proposed 2019 Inpatient Prospective Payment System

On April 24, 2018, the Centers for Medicare & Medicaid Services (CMS) released the proposed Inpatient Prospective Payment System (IPPS) for 2019. In the proposed rule the current CMS administration continues to unwind the quality reporting complexity instituted under the previous administration. Under the new leadership the agency’s priority has been to reduce reporting burdens so that hospitals can divert staff from paperwork to patient care. The Agency’s administration has been focused on defining a smaller set of patient-centered outcome measures.

Will the MIPS be Repealed in the Near Future?

While the attention of most physician organizations has been on implementation of the Merit-based Incentive Payment System (MIPS), it is possible that this program may soon be radically altered or discarded through Congressional action. In its March report to Congress, the influential Medicare Payment Advisory Commission (MedPAC) has taken a strong stance that MIPS should be repealed as soon as possible.

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