Medicare Physician Fee Schedule(MPFS) using the RBRVS (Resource Based Relative Value Scale) as the main vehicle for implementing the fee schedule. Each year CMS proposes changes to MPFS and then at the beginning of the calendar year implements the changes. Session Objectives: To briefly review the main components of MPFS. To discuss the broad range of changes being made to MPFS including technical RVU changes as well as policy changes. To understand the changes in E/M payment and documentation requirements for CY2021. To appreciate the changes being made relative to the Sustainable Growth Rate (SGR), such as MIPS and APM incentives. To review proposed changes in the RVUs for selected physician specialties. To briefly review changes in CPT and HCPCs coding. To discuss the proposed change in the Global Surgical Package (GSP), To briefly discuss associated policy areas such as physician quality reporting and the physician compare website. To review changes in associated payment systems and services such as telehealth, anesthesia and the ambulance fee schedule (AFS). To discuss non-physician practitioners (NPPs) special changes that are being made relative to NPPs. To review the possible impact of the proposed changes on different specialty areas. To discuss related issues such a provider-based clinics and special services such as observation services. Session Agenda: Review of MPFS and RBRVS Use of Relative Value Unit Work Component Practice Expense Component Malpractice Component Conversion Factor and SGR Updating of RVUs Geographic Adjustments for MPFS Non-Physician Practitioner Involvement Major Policy Areas for the MPFS Other Areas Affected by the MPFS Review Code Set Changes CPT HCPCS EM Payment and Documentation Changes for CY2021 Changes Being Made to MPFS/RBRVS for CY2019 RVU Changes Conversion Factor and SGR Site-of-Service Consideration Changes in GPCIs Facility vs. Non-Facility Practice Expense RVUs Radiation Oncology Future Changes and Trends Global Service Changes(GSP) GSP Basics Problem Areas for Physicians to Report Correctly Discontinuing 10-Day and 90-Day Global Periods Possibly Impacts on Physicians and Clinics Commenting to the Proposed Changes MACRA 2015 MIPS – Merit-Based Incentive Payment System APM – Alternative Payment Model Timing of Changes Payment Impacts Associated Areas of Concern Ambulance Fee Schedule Anesthesia Fee Schedule Telehealth Non-Physician Practitioner Health Information Technology Physician Quality Reporting Provider-Based Clinics The Future of MPFS and RBRVS

1. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 1
MPFS Update for CY2019
Sponsored By:
Beaverton Regional Hospital
Beaverton, Oregon
Presented By:
Duane C. Abbey, Ph.D., CFP

2. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 2
This workshop and other material provided are designed to provide accurate and
authoritative information. The authors, presenters and sponsors have made every
reasonable effort to ensure the accuracy of the information provided in this
workshop material. However, all appropriate sources should be verified for the
correct ICD-9-CM Codes, CPT/HCPCS Codes and Revenue Center Codes. The
user is ultimately responsible for correct coding and billing.
The author and presenters are not liable and make no guarantee or warranty;
either expressed or implied, that the information compiled or presented is error-
free. All users need to verify information with the Fiscal Intermediary, Carriers,
other third party payers, and the various directives and memorandums issued by
CMS, DOJ, OIG and associated state and federal governmental agencies. The
user assumes all risk and liability with the use and/or misuse of this information.
Disclaimer

3. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 3
Presentation Faculty
Duane C. Abbey, Ph.D., CFP – Dr. Abbey is a healthcare consultant and educator with over 20
years of experience. He has worked with hospitals, clinics,
physicians in various specialties, home health agencies and other health care providers.
His primary work is with optimizing reimbursement under various Prospective Payment
Systems. He also works extensively with various compliance issues and performs
chargemaster reviews along with coding and billing audits.
Dr. Abbey is the President of Abbey & Abbey, Consultants, Inc. A wide range of consulting
services is provided across the country including charge master reviews, APC compliance
reviews, in-service training, physician training, and coding and billing reviews.
Dr. Abbey is the author of fourteen books on health care, including:
•“Non-Physician Providers: Guide to Coding, Billing, and Reimbursement”
•“Emergency Department: Coding, Billing and Reimbursement”, and
•“Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance”.

4. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 4
➢ To briefly review the main components of MPFS.
➢ To discuss the broad range of changes being made to MPFS including
technical RVU changes as well as policy changes.
➢ To understand the changes in E/M payment and documentation
requirements for CY2021.
➢ To appreciate the changes being made relative to the Sustainable Growth
Rate (SGR), such as MIPS and APM incentives.
➢ To review proposed changes in the RVUs for selected physician
specialties.
➢ To briefly review changes in CPT and HCPCs coding.
➢ To discuss the proposed change in the Global Surgical Package (GSP),
➢ To briefly discuss associated policy areas such as physician quality
reporting and the physician compare website.
MPFS Update for CY2019
Objectives

5. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 5
MPFS Update for CY2019
Objectives
➢ To review changes in associated payment systems and services such as
telehealth, anesthesia and the ambulance fee schedule (AFS).
➢ To discuss non-physician practitioners (NPPs) special changes that are
being made relative to NPPs.
➢ To review the possible impact of the proposed changes on different
specialty areas.
➢ To discuss related issues such a provider-based clinics and special
services such as observation services.

6. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 6
MPFS Update for CY2019
Topic Overview
➢ Topics → See November 23, 2018 Final Federal Register  852 Pages Long
(!!) Much Material and Many Topics
▪ Potentially Misvalued Codes.
▪ Communication Technology-Based Services.
▪ Provisions Expanding Telehealth Services for the Treatment of Opioid
Use Disorder and Other Substance Use Disorders under the SUPPORT
Act.
▪ Valuation of New, Revised, and Misvalued Codes.
▪ Payment Rates under the PFS for Nonexcepted Items and Services
Furnished by Nonexcepted Off-Campus Provider-Based epartments of
a Hospital.
▪ Evaluation & Management (E/M) Visits.
▪ Therapy Services.

7. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 7
MPFS Update for CY2019
Topic Overview
➢ Topics
▪ Part B Drugs: Application of an Add-on Percentage for Certain
Wholesale Acquisition Cost (WAC)- based Payments.
▪ Potential Model for Radiation Therapy.
▪ Clinical Laboratory Fee Schedule.
▪ Ambulance Fee Schedule — Provisions in the Bipartisan Budget Act of
2018.
▪ Rural Health Clinics (RHCs) and Federally Qualified Health Centers
(FQHCs).
▪ Appropriate Use Criteria for Advanced Diagnostic Imaging Services.
▪ Medicaid Promoting Interoperability Program Requirements for Eligible
Professionals.

8. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 8
MPFS Update for CY2019
Topic Overview
➢ Topics
▪ Medicare Shared Savings Program Quality Measures.
▪ Physician Self-Referral Law.
▪ Physician Self-Referral Law: Annual Update to the List of CPT/HCPCS
Codes.
▪ CY 2019 Updates to the Quality Payment Program (including the
extreme and uncontrollable circumstances MIPS eligible linicians faced
as a result of widespread catastrophic events affecting a region or
locale in CY 2017).

9. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 9
MPFS Update for CY2019
Topic Overview
➢ Comments Requested
▪ Comments in response to the Request for Information on Promoting
Interoperability and Electronic Healthcare Information Exchange
through Possible Revisions to the CMS Patient Health and Safety
Requirements for Hospitals and Other Medicare- and Medicaid-
Participating Providers and Suppliers.
▪ Comments in response to the Request for Information on Price
Transparency: Improving Beneficiary Access to Provider and Supplier
Charge Information.
➢ Additional Topics
▪ Medicare Shared Savings – ACOs

10. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 10
MPFS Update for CY2019
Topic Overview
➢ Topics
▪ Shared Savings
▪ Value-Based Payments
▪ MACRA
▪ Medicare Diabetes Prevention Program (MDPP)  Major!
▪ Non-Excepted Section 603 Clinics
➢ Related Additional Topics
▪ MACRA MIPS – Merit-Based Incentive Program – See SGR Replacement
• June 30, 2017 Federal Register – Proposed (491 Pages Long!)
• November 16, 2017 Federal Register – Final (662 Pages Long!)
▪ Episodic Payment Model
• December 1, 2017 Federal Register – Final (Only 39 Pages Long)

11. © 2003-2019 Abbey & Abbey, Consultants, Inc. Slide # 11
Thank You
➢ For More information visit https://skillacquire.us/