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The 2019 Medicare Physician Fee Schedule Rule, as proposed by the Centers for Medicare and Medicaid Services (CMS) in July 2018, garnered thousands of comments from the physician community. The overwhelming majority of these focused on the CMS proposal to blend the 5 levels of office visit codes into 2 level 1s, and then to combine levels 2 to 5. As I have anticipated, the proposal was not well-received. Couched in terms of reducing physician burden, it sounded good until one realized that most physicians would find their reimbursement drastically reduced. Rheumatologists were projected to be hit especially hard with a reduction in Medicare payments of 7% to 20%, depending upon the physician’s payer and service mix.
Here are the changes that will be effective January 1, 2019:
Physicians and their staff should keep in mind that these changes are only for Medicare beneficiaries, and only when reporting E/M office visit codes. We should be on the lookout for further information and guidance on these changes from CMS and other payers.
Going forward, physicians must remain vigilant as CMS does intend to implement significant reductions in the current payment variation in E/M office/outpatient visit levels by paying a single blended rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patient visits) beginning in 2021. This will result in 3 levels of service, rather than the current 5, and will, of course, result in payment reductions.
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