Policy: CMS Delivers Some Shockers in CY 2019 MPFS Proposed Rule

Why This Topic Matters

The proposed rule touches multiple Medicare payment and workflow areas that can affect reimbursement, documentation practices, and adoption of new service models. Readers who follow Medicare policy updates will want to know which broad areas CMS is changing and what parts of the rule may affect their organizations.

Article Sections

1. Overview

   Introduces the proposed rule and frames the broader policy direction CMS is taking for the year. Sets up the main operational and reimbursement themes covered later in the article.

2. Context

   Provides background on CMS’s proposal and the agency’s stated priorities. Summarizes the high-level impact on Medicare Part B payment and documentation policy.

3. Conversion factor

   Discusses the proposed annual update to the physician fee schedule conversion factor. Notes the direction of the change and its relevance to payment rates.

4. Telehealth

   Covers telehealth-related additions and Medicare policy updates tied to remote service delivery. Also references legislation affecting telehealth requirements for certain beneficiaries.

5. Virtual care

   Summarizes proposed payment changes related to virtual service interactions and remote image review. Focuses on digital communication and monitoring categories.

6. Part B drugs

   Addresses proposed changes affecting payment methodology for certain Part B drugs. Highlights how CMS is approaching new-drug payment during periods when pricing information may be unavailable.

7. Medicare Advantage

   Describes a proposed demonstration affecting participation requirements for Medicare Advantage providers under the quality payment framework. Notes the connection to alternative payment arrangements.

8. Next steps

   Points readers to additional areas included in the larger proposed rule beyond the article’s summary. Mentions other Medicare payment and policy topics covered in the broader rule.