New Payment Rulings Could Affect You

November 6th, 2017 - Wyn Staheli, Director of Research
Categories:   Billing   Reimbursement   MIPS|PQRS|PQRI  
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Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems:

  1. Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
  2. Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018
  3. HHAs: Payment Changes for 2018
  4. Quality Payment Program Rule for Year 2

Of these four rulings, the physician fee schedule rule and the Quality Payment Program Rule are the most applicable to doctors of chiropractic. Please note that these rulings do change some of the information that was included in Chapter 2 and Chapter 6 of the 2018 ChiroCode DeskBook.

This article only contains a brief overview of some of the key points. To read a more comprehensive analysis of all four rulings, see “Four Final Rules Affecting CMS Payments for 2018”.

Physician Fee Schedule

This final rule includes a new Patients over Paperwork initiative, RVU changes, and much more. When considering fees, always keep in mind that fees are adjusted based on quality program initiatives. The final conversion factor for 2018 is set as $35.99 (an increase from $35.89 for 2017).

The following are some highlights from the Final Rule:

Code

2018 RVU**

2017 RVU

98940

.81

.76

98941

1.16

1.11

98942

1.51

1.44`

98943

.78

.73

** These are the proposed non-facility values since the final RVU file was not released at the time of publication. The ChiroCode Online Library (available to premium members) will include final RVUs as soon as they are available.

CLICK HERE to read the Press Release.

CLICK HERE to read the Final Rule.

Quality Payment Program Rule for Year 2

CMS kept some of the transition year policies and made some other changes designed to reduce the burden of provider participation. Please note that there were some changes from the Proposed Rule. Some key points are:

Note: See Chapter 2.5 of the 2018 ChiroCode DeskBook for more about the Quality Payment Program.

CLICK HERE to read the Final Rule Overview.

CLICK HERE to read the Executive Summary.

CLICK HERE to read the Press Release.

CLICK HERE to read the Final Rule.

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