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Radiology Escapes Big Cuts To Medicare Payments In 2019

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).

Radiology Escapes Big Cuts To Medicare Payments In 2019

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