ACR praises coding changes in CY2020 physician fee schedule, urges further updates

Paula Marchetta

The American College of Rheumatology in comments submitted to CMS praised the agency for provisions added to the CY2020 Physician Fee Schedule that would increase Medicare reimbursement for E/M services, while also calling for further changes.

“We applaud CMS for taking steps to ensure rheumatologists and other cognitive specialists are adequately reimbursed for the time-intensive, high-value services they provide,” Paula Marchetta, MD, MBA, president of the ACR, said in a press release. “These proposed changes will help ensure Medicare beneficiaries living with rheumatic disease can continue to receive the health care services they need and deserve.”

According to the ACR, the changes to E/M coding “represent a welcome reversal” from a previous CMS proposal that would have cut reimbursement for such services, which include examinations, disease diagnosis, risk assessments and care coordination. The group added that the new CMS provision increasing reimbursement would “appropriately reflect the time and expertise these face-to-face services require.

In their press release, the ACR cited a 2018 report from the Medicare Payment and Advisory Commission — a 17-member federal body that advises Congress on Medicare — that stated these services are “grossly under-compensated” under the program.

Department of Health & Human Services 
The ACR in comments submitted to CMS praised the agency for provisions added to the CY2020 Physician Fee Schedule that would increase Medicare reimbursement for E/M services.
Source: Adobe

However, the ACR also urged CMS to adopt additional changes to its upcoming CY2020 fee schedule. These include:

  • Clarify that proposed documentation reduction requirements take place in calendar year 2020;
  • Make participation in the Merit-based Incentive Payment System (MIPS) Value Pathway program voluntary, and based on measures that are “meaningful to clinical care;”
  • Reverse the removal of specific Qualified Clinical Data Registry Measures, particularly the planned removal of measures “178: Rheumatoid Arthritis: Function Status Assessment” and “182: Functional Outcome Assessment;” and
  • Work with the Center for Medicare and Medicaid Innovation to adopt alternative payment model options that would encourage more providers to participate in disease-specific physician focused models.

“The ACR remains dedicated to ensuring that rheumatologists and rheumatology interprofessional team members have the resources they need to work with CMS and provide patients with high-quality care,” Marchetta said in the release. “In order to achieve those objectives, payment programs must be designed to reflect the way clinicians treat patients. We hope to continue serving as a resource to the agency as it moves forward with the rulemaking process.” – by Jason Laday

Paula Marchetta

The American College of Rheumatology in comments submitted to CMS praised the agency for provisions added to the CY2020 Physician Fee Schedule that would increase Medicare reimbursement for E/M services, while also calling for further changes.

“We applaud CMS for taking steps to ensure rheumatologists and other cognitive specialists are adequately reimbursed for the time-intensive, high-value services they provide,” Paula Marchetta, MD, MBA, president of the ACR, said in a press release. “These proposed changes will help ensure Medicare beneficiaries living with rheumatic disease can continue to receive the health care services they need and deserve.”

According to the ACR, the changes to E/M coding “represent a welcome reversal” from a previous CMS proposal that would have cut reimbursement for such services, which include examinations, disease diagnosis, risk assessments and care coordination. The group added that the new CMS provision increasing reimbursement would “appropriately reflect the time and expertise these face-to-face services require.

In their press release, the ACR cited a 2018 report from the Medicare Payment and Advisory Commission — a 17-member federal body that advises Congress on Medicare — that stated these services are “grossly under-compensated” under the program.

Department of Health & Human Services 
The ACR in comments submitted to CMS praised the agency for provisions added to the CY2020 Physician Fee Schedule that would increase Medicare reimbursement for E/M services.
Source: Adobe

However, the ACR also urged CMS to adopt additional changes to its upcoming CY2020 fee schedule. These include:

  • Clarify that proposed documentation reduction requirements take place in calendar year 2020;
  • Make participation in the Merit-based Incentive Payment System (MIPS) Value Pathway program voluntary, and based on measures that are “meaningful to clinical care;”
  • Reverse the removal of specific Qualified Clinical Data Registry Measures, particularly the planned removal of measures “178: Rheumatoid Arthritis: Function Status Assessment” and “182: Functional Outcome Assessment;” and
  • Work with the Center for Medicare and Medicaid Innovation to adopt alternative payment model options that would encourage more providers to participate in disease-specific physician focused models.

“The ACR remains dedicated to ensuring that rheumatologists and rheumatology interprofessional team members have the resources they need to work with CMS and provide patients with high-quality care,” Marchetta said in the release. “In order to achieve those objectives, payment programs must be designed to reflect the way clinicians treat patients. We hope to continue serving as a resource to the agency as it moves forward with the rulemaking process.” – by Jason Laday