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The Effect of the 2019 Medicare Physician Fee Schedule on Anesthesia Reimbursements

By January 18, 2019 No Comments

As an anesthesiologist, you are likely aware that the 2019 Medicare Physician Fee Schedule will go into effect on January 1, 2019. The new fee schedule includes updates to numerous medical service strategies including the Quality Payment and Medicare Shared Savings Programs, the Laboratory Fee Schedule, and Physician Self-Referral. It is vital that anesthesia providers understand how this new fee schedule will affect their reimbursements.

The national conversion factor for anesthesia will experience a slight change when the 2019 Medicare Physician Fee Schedule comes into effect. The conversion factor will increase under the new schedule from $22.1887 to $22.2730.1 Initially, the Medicare Access and Chip Reauthorization Act (MACRA) specified a 0.5 percent conversion factor increase for anesthesia services. Despite this, the Bipartisan Budget Act of 2018, which generally expanded government discretionary spending limits, mandated a lower, 0.25 percent increase to the conversion factor. This update means that anesthesiologists will be able to charge higher fees for their services. The more expansive final physician conversion factor for specialties other than anesthesia will increase from $35.9996 to $36.0391. This conversion factor is useful for a variety of health care professionals, including anesthesiologists who charge flat-fee services. For instance, an anesthesiologist might use this conversion factor when charging a flat-fee for a service such as “the utilization of ultrasound direction in the arrangement of a nerve block.”2

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The updates made to the Quality Payment Program for 2019 take into account several new rules surrounding the Merit-Based Incentive Payment System (MIPS). If a clinician is MIPS eligible, their Medicare fee-for-service payments will be based on their MIPS results from 2017, which can undergo a maximum two percent increase after adjusting for budget neutrality.1 MIPS scores depend on performance in four categories: quality, promoting interoperability (utilization of information technology), improvement activities, and cost.3 The MIPS program, which currently includes certified registered nurse anesthetists, will be expanded in 2019 to incorporate new kinds of clinicians, such as dieticians. Those who are MIPS eligible can choose to be assessed within specific categories on activities that best reflect their practice. Furthermore, an extension of the low-volume threshold criteria of the Quality Payment Program will empower clinicians to opt out of MIPS if they wish. According to McDermott Consulting, “Per the 2019 LVT policy, to be excluded from MIPS, clinicians or groups will need to meet one of the following three criteria: have ≤ $90,000 in Part B allowed charges for covered professional services, provide care to ≤ 200 beneficiaries or provide ≤ 200 covered professional services under the PFS.” Groups of healthcare providers or individual practitioners will have the ability to opt into MIPS, provided that that they are not exempted by all the three of the low-volume threshold criteria.1

As indicated by Seema Verma, the Centers for Medicare and Medicaid Services (CMS) administrator, new documentation requirements will be streamlined under the new fee schedule, freeing-up clinicians to have the capacity to “put patients over paperwork.”2 These new documentation practices will make the paperwork process smoother by providing multiple options for healthcare practitioners when they approach billing patients. Overall, there are three important points to glean from the new physician fee schedule: first, the conversion factors relevant to anesthesiology practices are set to increase reimbursements, secondly, providers can expect more freedom to choose their level of involvement in the MIPS program, and lastly, regulations for filing bills and other paperwork will become more flexible and efficient.

References:

  1. Madhani, Sheila, and Mara McDermott. “Top 10 Takeaways: 2019 Medicare Physician Fee Schedule.” McDermott+Consulting, 6 Nov. 2018, mcdermottplus.com/insights/top-10-takeaways-2019-medicare-physician-fee-schedule/.
  2. Popa, Rachel. “What Anesthesia, Pain Management Providers Should Know about CMS’s 2019 Proposed Payment Rule: 6 Key Points.” Becker’s ASC Review, 23 July 2018, www.beckersasc.com/anesthesia/what-anesthesia-pain-management-providers-should-know-about-cms-s-2019-proposed-payment-rule-6-key-points.html.
  3. Quality Payment Program, qpp.cms.gov/mips/overview.