2018 Proposed MPFS: Will Your Specialty Take A Hit?

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Diagnostic Testing Facilities will be Impacted Most

In July 2017, CMS issued its 2018 Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule, hinting at a possible payment increase. The overall update to payments under the PFS based on the proposed CY 2018 rates would be +0.31 percent.

Clinical social workers top the pack of specialists who will benefit if the proposed Medicare physician reimbursement changes are finalized, with an estimated combined increase of 3 percent, while diagnostic testing facilities look to see the biggest reduction at minus six percent.

2018 Proposed MPFS Will Your Specialty Take A Hit

We bring you a highlight of how the proposed fee schedule will impact some key specialties:

Pathology

For Pathology, you should expect some good news and some bad news. On the bright side, the proposed conversion factor does not change much — up to 35.9903 as compared to this year’s 35.8887. However, payment for pathology services is likely to decline by 1 percent, while overall reimbursement for clinical labs will go down by 2 percent.

Technical component (TC) pay for some services, such as forensic cytopathology and cell marker study will look up. You can also expect a pay hike from 3 percent to 73 percent if your lab performs certain apheresis procedures.

On the other hand, pay for cytometry and 88323-TC will go down.

General Surgery

For general surgery too you can expect some ups and downs next year. The good news is that the proposed conversion factor does not change much — up from 35.8887 to 35.9903. But sadly, general surgery services across the board will go down by 1 percent.

Pay for certain tracheostomy services goes up, based on increase in RVUs characterized as potentially misvalued codes. While RVUs for 31600, 31267, and 19303 will decline.

Cardiology

Payments of cardiologists is likely to decrease by 2 percent in 2018 as compared to their 2017 pay.  Individual cardiologists may see a different percentage of change based on the services that cardiologist renders most.

Gastroenterology

Gastroenterologists will neither face significant increase in pay hikes nor see any drastic reduction. As per the fee schedule under the proposal, gastroenterology practices would see a minus one percent payment change.

Likewise, emergency departments will see a minus one percent payment change.

Note: These updates for your specialty may give you a rough idea, but it doesn’t mean that is what you will actually experience.

For a closer look at the detailed data and insight by specialty, go to https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-14639.pdf.

Or, keep an eye out for Medicare Compliance & Reimbursement for news on how CMS shapes the fee schedule going forward. Every month the newsletter covers Medicare compliance updates in an easy-to-understand format.