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CMS Announces 2018 Physician Payment and Policy Updates

August 17th, 2017

The Centers for Medicare & Medicaid Services (CMS) recently announced a proposed rule to update payment information and other policies related to physicians and other clinicians.

The overall update in payments under the Physician Fee Schedule (PFS) would be a positive value of 0.31%. This is calculated by adding positive 0.50% established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and reducing that by 0.19% as required by the Achieving a Better Life Experience (ABLE) Act of 2014, which requires reassessing of codes that are misvalued.

As part of this update, CMS also will expand its telehealth services footprint by adding several new codes to the menu for telehealth. Additionally, CMS has recommended that professionals should no longer need to report the telehealth modifier to reduce the administrative burden on those that seek to use these services.

CMS also addressed its implementation of the Medicare Appropriate Use Criteria (AUC) Program for Advanced Diagnostic Imaging, a program that is proposed to begin in 2019. In the first year, physicians would be required to report AUC data, but paid regardless of whether it appeared or not, to allow for program preparation. CMS proposed new entities that would help physicians transition to the AUC program. These qualified, provider-led entities would be available to physicians free of charge and count as credit under the Merit-Based Incentive Payment System (MIPS) as an improvement activity.

CMS also proposed changing the current Physician Quality Reporting System (PQRS) program policy that requires reporting of nine measures across three National Quality Strategy domains. The update would require reporting of only six measures for the PQRS. Additionally, CMS proposed these changes to the clinical reporting requirements under the Medicare Electronic Health Record Incentive Program.

There also are proposals made to streamline the Medicare Shared Savings Program rules for Accountable Care Organizations that are struggling to streamline operations. Finally, there are adjustments to the MIPS 2018 value modifier.


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