By now everyone has heard that the Centers for Medicare and Medicaid Services (CMS) has proposed to dramatically change the way physicians get paid for evaluation and management (E&M) services in the office as part of the proposed 2019 Physician Fee Schedule Rule. In fact, as of the end of July, CMS has received over 600 comments on the proposed rule, with virtually all of them criticizing the proposal. I suspect very few physicians have read the 55 pages describing CMS’ proposal and basing their comments on reporting by various agencies. I don’t fault anyone for not reading it; understanding CMS regulations is not for the faint of heart and I’d rather they spend time reading medical journals or novels and leaving it to those of us who do enjoy such tasks. With that, let me summarize the proposal.
In short, CMS is proposing to establish what they refer to as a blended rate. They looked at all claim data and used the distribution of billed codes over previous years to set a single reimbursement and RVU rate for every 99202-99205 new patient office visit and a single rate for every 99212-99215 established patient office visit. CMS likes blended rates; they use the same concept for paying hospitals under the DRG system. For some visits you get paid more than it costs and for some you get paid less but it all averages out in the end, or so they argue. It is clear that physicians disagree with this premise and are letting CMS know it.
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
