2019 Medicare Physician Fee Schedule and Quality Payment Program Final Rule

2019 Medicare Physician Fee Schedule and Quality Payment Program Final Rule

On Nov. 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released the 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP) final rule, which will be published in the Federal Register on Nov. 23, 2018. This is the first year CMS combined the Medicare PFS and QPP rules. CMS published several fact sheets on the final rule including a fact sheet on the QPP changes and a fact sheet on the PFS changes for 2019.

One week later, CMS released a snapshot of physician performance during the first year of the QPP, 2017. These data indicate that 93% of clinicians who were MIPS-eligible in 2017 will get a positive MIPS incentive payment in 2019.

AMA is continuing to review the rule and will work with its colleagues in the Federation to further analyze these policies in the coming weeks. Below is a summary of the key policies included in the final regulation and the QPP performance results.

On page 584 of the rule, CMS states: “We recognize that many commenters, including the AMA, the RUC, and specialties that participate as members in those committees, have stated intentions of the AMA and the CPT Editorial Panel to revisit coding for E/M office/outpatient services in the immediate future. We note that the 2-year delay in implementation will provide the opportunity for us to respond to the work done by the AMA and the CPT Editorial Panel, as well as other stakeholders. We will consider any changes that are made to CPT coding for E/M services, and recommendations regarding appropriate valuation of new or revised codes.”

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