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WHA Submits Comments on CMS’ 2020 Physician Fee Schedule Proposed Rule

October 01, 2019

WHA found a lot to support in its comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed CY 2020 Revisions to the Medicare Physician Fee Schedule. But because other parts of the rule have the potential to negatively impact members, WHA also voiced concerns. WHA’s comments are summarized:

Evaluation and Management (E/M) Documentation Revisions and Payment Changes. Responding to broad complaints about last year’s proposal to consolidate the five E/M coding levels into two levels, CMS now proposes to assign separate payments to all E/M visit levels for new and established patients. Further, CMS extended flexibilities finalized in last year’s rule to additional types of clinicians. Those flexibilities permitted physicians, residents and nurses to document a teaching clinician’s presence during the time the teaching clinician participates in services involving residents, rather than requiring the teaching clinician to document this information. Also, CMS proposes to establish a general principle that physicians, physician assistants, and advanced practice nurses may review and verify, rather than re-document, information included in the medical record by other members of the medical team. WHA expressed strong support for these changes.

Quality Payment Program (MACRA) Changes.
WHA was positive about many of CMS’ proposed changes to the Merit-Based Incentive Payments (MIPS) categories of Quality, Cost/Resource Use, Promoting Interoperability, and Improvement Activity, with the exception of adding 10 new measures to the cost category. However, WHA continues to stress to CMS that the MIPS cost measures still aren’t robust. WHA therefore opposed increasing the Cost/Resource Use category from 15% to 20% and decreasing the Quality category from 45% to 40% for the 2020 performance year. WHA urged CMS to maintain the cost category at 15% until clinicians have experience with a correct mix of cost measures and until more cost measures are endorsed by the National Quality Forum.

Proposed Payment Reductions for Specific Code Groups in 2020. In the rule, CMS proposes significant reductions to the relative value units (RVUs) of certain CPT code groups, including the code set that describes long-term EEG monitoring with video recording and the code set that describes myocardial PET scans. WHA opposed these significant reductions, saying these moves could potentially limit patients’ access to these vital services, and that decreases of this magnitude over a short time period will negatively impact physicians and hospitals that care for patients who need these critical services.

Coinsurance for Colorectal Cancer Screening Tests. CMS requested comment on whether it should introduce a notification requirement where physicians, or their staff, would be required to inform beneficiaries before a colorectal cancer screening that they may incur a coinsurance payment if the physician discovers and removes polyps. WHA strongly recommended that CMS use its existing resources to inform beneficiaries of their possible coinsurance requirement and that it is inappropriate to require providers to make this notification.

Payment for Therapy Services.
The rule proposed payment changes for therapy services when furnished concurrently, or separately within the same visit, by Physical Therapists/PT assistants and Occupational Therapists/OT assistants. If 10% or more of services in a therapy visit are furnished by a PT or OT assistant, the visit must be coded with a modifier indicating that threshold. Once the modifiers attach, the visit would be paid at 85% of the PT/OT reimbursement rate. The new coding requirements would take effect in the 2020 payment year. Payment cuts would be effective in the 2022 payment year. WHA opposed these payment changes.

WHA opposed CMS’ proposed approach to assigning these modifiers when team-based care is delivered.
WHA’s position is that only services furnished in whole or in part independently by the assistant should be attributed to the 10% de minimis standard for the assignment of the modifiers.

For more detailed information or questions about the proposed rule, contact WHA Vice President of Policy Development Laura Rose.


This story originally appeared in the October 01, 2019 edition of WHA Newsletter