LogixHealth Releases Review of 2018 Physician Fee Schedule Final Rule

BEDFORD, Mass., Jan. 31, 2018 -- LogixHealth has released its 2018 ED Physician Update, a comprehensive review of Medicare’s 2018 Physician Fee Schedule final rule as it relates to emergency physicians.

According to LogixHealth’s 2018 ED Physician Update, the 2018 rule is no longer governed by the Sustainable Growth Rate (SGR) formula, which had mandated annual cuts to physician payments, resulting in year-after-year eleventh-hour congressional rescues with short-term fixes. Instead, with the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), 2018 represents the second year of a stabilized conversion factor.

At the conclusion of 2017, the Medicare conversion factor (the amount Medicare pays per RVU) was set at $35.8887. MACRA provides for annual conversion factor payment increases of 0.5% through 2019. After accounting for several technical adjustments, the 2018 final rule published a conversion factor of $35.9996.

Each year, updated RVUs for physician services are published in the final rule. For 2018, the work RVUs for emergency medicine services remain unchanged. The total RVUs associated with ED E/M services 99281 through 99285 are essentially unchanged as well. The CMS specialty-specific impact analysis states that emergency medicine will experience a 0% update in overall Medicare reimbursement for 2018.

Also of interest, the Merit-Based Incentive Payment System (MIPS) is a payment mechanism that provides for annual reimbursement adjustments related to quality program requirements impacting 2020 payments based on 2018 reporting in four categories; Quality, Resource Use, Clinical Practice Improvement Activities, and Meaningful Use of an Electronic Health Record System. For the 2018 performance year (impacting 2020 payments), the four MIPS categories will be consolidated for most emergency physicians to include: 75% Quality (the old PQRS program), 10% Resource Use, and 15% Improvement Activities. LogixHealth's 2018 ED Physician Update newsletter includes further detail outlining the payment program.

Additionally, in 2018 ED E/M work RVUs potentially will be revalued. The final rule highlighted concerns that ED E/M services may be undervalued. According to Elijah Berg, M.D., CEO of LogixHealth, “CMS has recommended that the Relative Value Update Committee (RUC) survey and potentially revalue the work RVUs associated with the 99281-99285 CPT codes. This survey will take place in 2018 and updated work RVUs, if any, would likely be in effect in 2019.”

In the 2018 Physician Fee Schedule, proposed rule CMS sought comments regarding the 1995 and 1997 Documentation Guidelines and their current relevance to clinical practice. The commentary and response was robust and CMS devoted substantial space in the 2018 physician final rule to review an assessment of the value of the current Documentation Guidelines with particular focus on assessing the provider burden of the history and exam components.

LogixHealth's 2018 ED Physician Update and Medicare’s 2018 Physician Fee Schedule final rule, can be found on the LogixHealth website:  www.logixhealth.com.

About LogixHealth:
LogixHealth provides expert coding and billing for top hospitals, emergency departments and office-based practices nationwide, servicing more than 10 million patient visits annually across over 40 states. We provide tools and resources to optimize financial performance and improve the quality of care. For more information, visit www.logixhealth.com.

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