LogixHealth Releases Review of 2019 Physician Fee Schedule Final Rule

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Feb 20, 2019, 08:45 ET

BEDFORD, Mass., Feb. 20, 2019 /PRNewswire/ -- LogixHealth has released its 2019 ED Physician Update, a comprehensive review of Medicare's 2019 Physician Fee Schedule final rule as it relates to emergency physicians.

According to LogixHealth's 2019 ED Physician Update, the 2019 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), 2019 represents the third year of a stabilized conversion factor.

At the conclusion of 2018, the Medicare conversion factor (the amount Medicare pays per RVU) was set at $35.9996. MACRA provides for annual conversion factor payment increases of 0.5% through 2019 which was decreased to 0.25% by the Balanced Budget Act of 2018. After accounting for several technical adjustments, the 2019 final rule published a conversion factor of $36.0391.

Each year, updated RVUs for physician services are published in the final rule. For 2019, 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 with only a small change to the RVUs for 99291. The CMS specialty-specific impact analysis states that emergency medicine will experience a 0% update in overall Medicare reimbursement for 2019.

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 2021 payments based on 2019 reporting in four categories; Quality, Resource Use, Clinical Practice Improvement Activities, and Meaningful Use of an Electronic Health Record System. For the 2019 performance year (impacting 2021 payments), the four MIPS categories will be consolidated for most emergency physicians to include: 70% Quality (the old PQRS program), 15% Resource Use, and 15% Improvement Activities. LogixHealth's 2019 ED Physician Update newsletter includes further detail outlining the payment program.

Additionally, last year the 2018 final rule highlighted concerns that ED E/M services may be undervalued and as a result the Relative Value Update Committee (RUC) has surveyed our codes. According to Elijah Berg, M.D., CEO of LogixHealth, "The American College of Emergency Physicians' RUC team developed robust arguments supporting the higher acuity of Emergency Department patients and the additional resources required to care for sicker patients with greater comorbidities. The RUC will be making its recommendations to CMS and the final RVUs for our important ED E/M codes will be updated and published with the 2020 Physician final rule."

CMS has been evaluating changes to the overall Documentation Guidelines and the 2019 rule opts for a measured approach. While there will be no changes to the ED code documentation requirements, the office visits codes will undergo a major restructuring in two years (2021). For 2019 and 2020, CMS will continue the existing documentation requirements for all services.

LogixHealth's 2019 ED Physician Update and Medicare's 2019 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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