By Kate Madden Yee, AuntMinnie.com staff writer

July 13, 2018 -- Radiology will largely escape major cuts in reimbursement for Medicare studies in 2019, according to a proposed Medicare Physician Fee Schedule (MPFS) for next year released on July 12 by the U.S. Centers for Medicare and Medicaid Services (CMS).

There will be no change in reimbursements for radiology and interventional radiology, while nuclear medicine will see a decrease of 1% and radiation oncology/radiation therapy a decrease of 2% if the proposal is finalized in November. The agency estimated a 2019 conversion factor of $36.04, a slight increase from the current conversion factor of $35.99.

In addition, CMS is proposing 60 new and revised radiology codes for 2019, increasing values for some and decreasing values for others, the American College of Radiology (ACR) said.

"Our current procedural terminology and relative value scale update committee teams worked very hard to achieve accurate payment rates for radiology services," the ACR said in a statement. "Staff will be reviewing the rule in detail to determine why CMS decided to decrease the values for some of the radiology codes."

Moving forward with AUC

The proposed rule also addresses the agency's plan to move forward with appropriate use criteria (AUC) and clinical decision support (CDS) for diagnostic imaging services on January 1, 2020. This date will kick off a one-year testing period for the program, and the rule proposes a series of G-codes and modifiers for claims processing during this time.

The agency also recommended adding independent diagnostic testing facilities (IDTFs) to the list of eligible settings for the AUC program, which already includes physician offices, hospital outpatient departments, and ambulatory surgical centers, the ACR said.

Finally, CMS is expanding its list of "significant hardship" criteria for complying with the AUC program to include insufficient internet access and electronic health record or clinical decision-support mechanism vendor problems.

"The ACR appreciates CMS' efforts to move forward with the implementation of this important, congressionally mandated utilization program," the ACR said.

Quality program changes

To implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS established its Quality Payment Program (QPP), which includes two options for physician participation: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). This rule proposes changes to the QPP, including removing MIPS process-based quality measures that clinicians say are low-value or low-priority, and revamping the MIPS "promoting interoperability" performance category, according to CMS.

"The proposed changes to QPP aim to reduce clinician burden, focus on outcomes, and promote interoperability of electronic health records," the agency said.

Off-campus provider payments

The Bipartisan Budget Act of 2015 mandated that certain items or services provided by off-campus hospital outpatient departments no longer be paid under the Hospital Outpatient Prospective Payment System (HOPPS); this policy was implemented on January 1, 2017. In 2018, CMS began paying for these services under the MPFS at 40% of the HOPPS rate, and this will continue in 2019, according to the proposed rule.

Supervising radiology assistants

The rule also recommends a revision to physician supervision requirements so that any diagnostic test performed by a radiologist assistant (RA) may be done under a direct level of physician supervision.

"This is in response to stakeholder comments that the current requirement of personal supervision that applies to some diagnostic tests is overly restrictive when the test is performed by an RA, and does not allow for radiologists to make full use of RAs," CMS said. "Reducing the required level of supervision will improve efficiency of care."

Historic changes?

With the proposed new rule, CMS is recommending historic changes that will modernize Medicare and "restore the doctor-patient relationship," in part by minimizing the burden of paperwork on physicians, according to the agency.

"Today's proposals deliver on the pledge to put patients over paperwork by enabling doctors to spend more time with their patients," said Administrator Seema Verma in a statement released by CMS. "Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care. This administration has listened and is taking action. The proposed changes to the Physician Fee Schedule and the Quality Payment Program address those problems head on, by streamlining documentation requirements to focus on patient care and by modernizing payment policies."

The agency is taking comment on the proposed rule until September 10.


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