decisionhealth Newsletters, Coder Pink Sheets - 2017 Issue 12 (December)
Conversion factor up but vaccines, cardio stress tests take payment hit
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Article Overview
This article reviews a set of 2018 CMS Medicare updates that affect physician payment and reporting workflows. It covers conversion factor changes, select service payment impacts, outpatient department policy changes, quality reporting thresholds, value modifier adjustments, Medicare diabetes prevention program timing, telehealth updates, shared savings assignment changes, and a delay in Appropriate Use Criteria implementation. The article is useful for practices, billing staff, coders, and compliance teams tracking annual fee schedule and CMS operational changes.
Why This Topic Matters
These updates can affect reimbursement, reporting burden, and administrative processes across common outpatient and physician services. Understanding the scope of the changes helps practices assess whether their service mix, quality reporting, telehealth, or Medicare participation workflows may be affected.
Article Sections
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Conversion factor and selected payment changes
Overview of the 2018 conversion factor and the general impact on reimbursement, along with selected service categories that saw payment changes.
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E/M documentation guidelines
Discussion of CMS’s position on documentation guideline revision and the general direction of future office visit documentation policy.
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Provider-based outpatient department payment policy
Summary of payment adjustments for certain off-campus, provider-based departments and the related exemption framework.
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PQRS minimum reporting and value modifier changes
Overview of changes to the quality reporting threshold and the associated value modifier adjustments for different group sizes.
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Medicare diabetes prevention program
Timing, participation window, and operational limits for the Medicare diabetes prevention program, including virtual session policy.
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Telehealth, 99091, and modifier updates
Discussion of new telehealth-related codes, changes to claim modifier use, and payment treatment for physiologic data collection services.
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Shared Savings beneficiary assignment changes
Coverage of primary care service code changes used for beneficiary assignment and other Shared Savings operational updates.
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Appropriate Use Criteria delay
Explanation of the delayed start date for Appropriate Use Criteria requirements and the limited early reporting option.
What You Will Learn
- How CMS’s annual fee schedule update can affect multiple outpatient and physician payment areas
- Which broad policy areas were revised in the 2018 final rule
- How telehealth, quality reporting, and shared savings policies were updated at a high level
- What administrative timelines were changed for Medicare diabetes prevention and appropriate use criteria
Who Should Read This
- Medical coders
- Billing staff
- Practice administrators
- Compliance teams
- Physician offices
- Outpatient facilities
Codes Discussed
Modifiers Discussed
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