Based on the Final Rule which was published in November 2018 the following is material pertinent to the Quality and Cost categories: Quality Category The Quality category carries a weight of 45% of your total MIPS score as compared to 50% last year. Claims-based measures can only be submitted by clinicians in a small practice (15 or fewer clinicians). This is the first year that claim submission has been limited by practice size, whether participating individually...

CMS released the 2019 Quality Payment Program Final Rule early November 2018.  Below are highlights of some of the key provisions for Year 3 (2019) of the QPP MIPS program that will go into effect 1/1/19. These are overall changes to the program in 2019. Changes to the MIPS performance threshold and the exceptional performance bonus: The MIPS performance threshold will double in 2019. MIPS eligible clinicians and groups will have to earn at least a...

Promoting Interoperability (PI) Performance category Of the four categories under MIPS, the PI Performance category will see the most change in 2019. The PI category carries a weight of 25% of your total MIPS score which is the same as the 2018 reporting period. In the 2019 reporting period eligible clinicians are required to a 2015 Edition CEHRT. There is no longer an option of using an earlier edition of CEHRT. CMS has eliminated the “base,...

CPT 2019 Summary of Changes CPT changes go into effect on 1/1/2019.  Please refer to the spreadsheet link here which contains the new/deleted/revised codes. There are 164 new CPT codes added which are high-lighted in green on the spreadsheet, 72 deleted codes which are high-lighted in pink and 49 revised code high-lighted in yellow with a description of the change from 2018 to 2019. There are no changes in the anesthesia and auditory system under surgery....

2018–2019 Influenza Season – Vaccine Chart   There are many different flu viruses and they are constantly changing. Each year research is done to determine the most common three or four viruses. The composition of U.S. flu vaccines is updated as needed on a yearly basis. For 2018-2019, trivalent (three-component) vaccines are recommended to contain: A/Michigan/45/2015 (H1N1)pdm09-like virus A/Singapore/INFIMH-16-0019/2016 A(H3N2)-like virus (updated) B/Colorado/06/2017-like (Victoria lineage) virus (updated) Quadrivalent (four-component) vaccines, which include protection from a second lineage of B viruses,...

The proposed rule for 2019 was released on July 12, 2018. Meridian Medical Management posted a high overview of proposed changes to Payment Policies under the Medicare Physician Fee Schedule. There are also changes proposed for the Quality Payment Program. Amongst the proposed changes are: Changing the definition of MIPS eligible clinicians to include physical therapists, occupational therapists, clinical social workers, and clinical psychologists. Having a third element of the low-volume threshold determination by adding...

The proposed rule that will affect some payments under the Medicare Physician Fee Schedule and/or payment methodologies was released by CMS on July 12, 2018. This is a high overview of some of the changes; all clients should review the proposed rule to identify any categories that may affect them. Once the proposed rule is published on July 27, 2018 the comment period will be open until September 10, 2018. All comments must be submitted...

2017 Final MIPS Performance Feedback is now available. Special scoring circumstances and all MIPS data submitted or calculated for an individual clinician, group, or APM Entity will be reflected. Final MIPS Performance Feedback includes the 2017 Final Score, 2019 Payment Adjustment Information, and details about measures and activities. Clinicians that participated in either track of the 2017 Quality Payment Program, MIPS or APMs, may now access feedback reports on their 2017 Performance Reporting. CMS has completed...

The Center for Disease Control released the 2019 ICD-10 CM codes which are effective October 1, 2018 through September 31, 2019. The release includes 279 new codes, 51 deleted codes, and 143 revised codes.  As of October 1, 2018, there will be 71,932 active ICD-10 CM codes.   The following chapters have the most changes: Chapter 2: Neoplasms - all 45 new codes in this chapter are related to the upper/lower eyelids right or left eye Chapter...

July brings changes to the 2018 Medicare Physician Fee Schedule Database (MPFSDB).  Changes are effective for dates of service beginning July 1, 2018. PE RVU Imaging Code Changes CPT Code 71045 (radiologic examination, chest, single view, frontal) and CPT Code 71046 (radiologic examination, chest, two views, frontal and lateral) have changes to the Facility and Non-Facility PE RVUs. 71045 will change to 0.42 and 71046 will change to 0.35. Indicator Change for RHC and FQHC Care Management...