<img alt="" src="http://www.poiuy12.com/102832.png" style="display:none;">
    Welcome to the ClaimCare Medical Billing Blog. We strive to provide content that improves the overall quality of medical billing efforts across the US. If you have any specific topics that you would like to see addressed in this medical billing blog please post the topic in the Medical Billing Questions & Answers Forum. If you have an article that you would like considered for publication in the medical billing blog then please email your article to resources@claimcare.net.


    Impact of Medicare 2019 E&M code changes on a physician compensation package based on RVU

    Posted by Carl Mays on Mon, Sep 24, 2018 @ 04:55 AM

    2018 09 22 - Imact of medicare changes on RVU based comp

    The Centers for Medicare & Medicaid Services (CMS) just issued a proposed ruling to the Medicare Physician Fee Schedule (PFS) last July 12, 2018. This will take effect on or after January 1, 2019.

    This article discusses the impact this will have on the physician's relative value unit (RVU) based on their practice (directly and indirectly), and a list of potentially misvalued services to watch out in 2019.

    Why is it important for physicians to know the upcoming RVU calculation changes in the proposed Medicare 2019?

    Physicians can earn up to 7% of their Medicare Part B payments in 2021 based on their Medicare 2019. Here is what the vice president of public policy of the American Medical Group Association (AMGA), Chet Speed has to say about it:

    "When you think about incentives, generally, you need both a carrot and a stick to make change. With Medicare moving to a value-based system, you need a carrot, in the form of higher payments for doing well, and you need a stick, if you don’t do well, you have less reimbursements. "

    How will this impact your practice? Here are some of the calculation changes and adjustments that will take effect on your RVU:

    Practice Expense Methodology Calculation Changes

    Medicare 2019 will be incorporating two new specialties, which will affect hospitalists and advanced transplant cardiology and heart failure physicians.

    Calculation Changes to Direct PE Inputs for Specific Services

    Standardization of the following specific services is expected in the proposed Medicare 2019:

    • Clinical labor tasks
    • Balloon sinus surgery kit comment solicitation
    • Scope systems' equipment recommendation
    • Existing direct PE inputs updated prices

    This includes an update on the prices of the following supplies and equipment:

    EQ370: Biopsy guidance software and breast MRI computer aided detection

    SA036: Transurethral microwave thermotherapy together with the kit

    SA037: Transurethral needle ablation together with the kit

    SK050: Neurobehavioral status forms

    SL140: Wright's Pack (per slide) and the stain

    Calculation Changes to the Indirect PE of Certain Office-Based Services

    The indirect PE RVUs for those working in a non-facility setting is expected to increase due to the direct PE costs applied to them. This is because the greater value between the clinical labor costs and the work RVUs in relation to the direct costs of these services will be the value selected in determining their RVU.

    List of Potentially Misvalued Services for 2019

    Aside from changes to the practice expense methodology calculation, the General Accounting Office and MedPac have also listed the following "potentially misvalued services." This is based on a high volume of codes submitted for review by their office to the CMS.

    • Colonoscopy w/lesion removal (45385)
    • CT head w/o contrast (70450)
    • EGD biopsy single/multiple (43239)
    • Electrocardiogram complete (93000)
    • Revision of heart chamber (92992)
    • Total knee arthroplasty (27447)
    • Total hip arthroplasty (27130)
    • TTE w/doppler complete (93306)

    An additional 72 separate code groups for specific codes are currently on review by the CMS. This is after it has taken a closer look at the rationale provided by the American Medical Association/Specialty Relative Value Scale Update Committee.

    Comments on these proposed new valuations are welcomed by the committee. You may submit yours on or before September 10, 2018 for it to be considered.

    Impact on Specialty Specific Health Sectors

    Those working on specialty specific health sectors, such as the following medical professionals, are also most likely to experience the following adjustments in their overall payment:

    • 3% increase for nurse practitioners
    • 4% increase for gynecology/obstetrics
    • 3% decrease for oncology/hematology
    • 4% decrease for dermatology

    Given these changes, surprise medical bills and price transparency remains to be the issues facing suppliers and providers.

    Would you like more updates about the Medicare 2019 E&M code changes?

    Subscribe to our blog to remain posted. Share the knowledge and hit the share buttons.

    Tags: medical billing education, medical billing resources, medical billing coding, 2019 Medicare Changes

    Subscribe by Email

    Most Popular

    Browse the Medical Billing Blog by Tag

    Medical Billing Blog Requests

    If you have  specific topic or question you would like to see covered in this blog then please post the question on the Medical Billing Question & Answer Forum.

    If you have a question about ClaimCare's Medical Billing Services please utilize the form below.

    Contact Us