Do You Know as Much as You Should About the Medicare Fee Schedule?


Get Ready for the Annual Update by Reviewing Current PFS Highlights

It’s not as highly anticipated as the new NFL season kickoff or the return of pumpkin spice, but CMS’ annual revisions to the Medicare Physician Fee Schedule (PFS) are a fixture of the fall season.

We never know exactly what the new year’s PFS will contain, although the 2019 proposed rule’s drastically reduced E/M documentation requirements and single payment structure for level 2 through level 5 visits caused a stir when published last summer. But we see the details every November: the size of any physician payment rate increase, the revaluations of some reimbursement rates for CPT® codes, the addition or deletion of new codes altogether, new and expanded reimbursement opportunities, and more.

Being a busy practitioner, you don’t have time to read the new Medicare fee schedule each autumn. But of course, you want the highlights. No other single document has a more direct impact on how much you get paid for evaluating and treating Medicare beneficiaries. And plenty of private insurers take their reimbursement cues from the PFS, which makes knowing its contents even more important.


The 2018 Medicare Physician Fee Schedule in Review

At MDCodePro, we help you strengthen your documentation so you can always assign patient visits their optimal CPT® codes — the codes that bring you the most money you’ve legitimately earned for your work.

So here are some of the 2018 PFS’ many provisions we thought most notable. This year’s PFS:

  • Implemented a 0.41% physician payment rate increase. The amount reflects the 0.5% increase for 2018 established in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, reduced as the Achieving a Better Life Experience (ABLE) Act of 2014 requires when the estimated net reduction of PFS expenditures for misvalued codes doesn’t meet a year’s target.
  • Raised the PFS conversion factor to $35.99. The conversion factor (CF) is the monetary amount by which relative value units (RVUs) are multiplied to calculate Medicare provider reimbursement. The 2018 CF is one dime higher than the 2017 CF.
  • physician payment rate increaseAllowed physicians to report Level II Healthcare Common Procedural Coding System (HCPCS) code modifiers as patient relationship categories. These categories determine which physician is accountable for a patient’s cost of care. They classify services as broad or focused, continuous or episodic, or only as ordered by another clinician. The voluntary period the PFS establishes allows physicians adequate time to practice using them properly before, at some point, they become mandatory.
  • Moved closer to site-neutral payments. The 2018 PFS reduced payments to certain off-campus hospital outpatient provider-based departments by 20% as part of CMS’ continuing shift to “site-neutral” payments. This is intended to rein in Medicare provider reimbursement expenses and “level the playing field” between hospitals and physician practices.
  • Added new CPT® codes. Providers can now use several new HCPCS and CPT® codes related to telemedicine, including the unbundled CPT code 99091, which lets providers receive separate payment for time spent collecting and interpreting remote patients’ data. The PFS also replaces several Medicare G-codes for reporting care management services with CPT® codes.
  • Expanded the Medicare Diabetes Prevention Program (MDPP). CMS’ response to the nation’s diabetes crisis educates prediabetic beneficiaries about health and lifestyle changes they can make to delay or prevent the disease’s onset. The 2018 PFS includes the policies providers need to implement MDPP and get paid for it.

2018’s PFS final rule also summarized comments, solicited in the proposed rule, about revising CMS’ E/M documentation guidelines. The rule noted widespread support for such revision but offered no consensus about what revisions would be best.

You can be sure we’ll weigh in on the revisions the 2019 final rule brings, as well as other provisions specifically affecting documentation and coding.


Grow Your Revenue Much Faster Than the Medicare Fee Schedule Can

You can also be sure, no matter what each fall’s final PFS rule holds, that the MDCodePro app can help you and your organization document and code patient visits more accurately, efficiently, compliantly, and profitably starting right now.

Why settle for whichever small physician payment rate increase is in next year’s PFS when you could start growing your bottom line a lot more through better documentation and optimal coding today?

The hundreds of physicians who’ve already learned and started putting the MDCodePro method into practice have grown their revenue, on average, by $30,000 a year.

Discover the difference MDCodePro can make for you. Click here to request more information.

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