What You Need to Know About the Final 2019 Medicare Physician Fee Schedule and Quality Payment Program Rule

January 8, 2019

Reimbursement cuts for certain oncology specialties, changes in documentation requirements for certain E&M services, reduced reimbursement for new Medicare Part B drugs, and new reporting thresholds and payment adjustments are some of the changes in the Medicare Physician Fee Schedule and the Quality Payment Program this year. In the latest ASCO in Action Podcast, ASCO CEO Dr. Clifford A. Hudis discusses the changes made to the physician fee schedule and the Quality Payment Program, and what this may mean for your oncology practice.

The physician feel schedule, which is a complete listing of payments and policies that Medicare uses, is updated each year and used to reimburse physicians and other providers working on a fee-for-service basis. This year, the Centers for Medicare & Medicaid Services estimates that there will be a one percent reimbursement cut for hematology oncology and radiation oncology specialties. However, the actual impact on any physician and practice will depend on the mix of services provided. Another provision in the final rule reduced the documentation required for evaluation and management (E&M) services. Code consolidation and changes in reimbursement for E&M services have been delayed until 2020.

Changes are coming to the Quality Payment Program this year, as well. The final payment adjustment in the Merit-based Incentive Payment System (MIPS) will now become plus or minus 7 percent, with adjustments to maintain budget neutrality and additional positive payments for exceptional performance. Another noteworthy change will be the increase in the MIPS performance threshold from 15 points in 2018 to 30 points in 2019.

While some of the changes will take place immediately, others, such as the consolidated billing levels, will have a delayed impact.

To learn more and hear all the changes happening to the MPFS and QPP rule for this year, listen to the full discussion.

You can subscribe to the ASCO in Action Podcast through iTunes and Google Play.