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MPFS 2019: HEALTHCARE TO SERVE YOU & YOUR CARETAKERS

Have you ever wondered why everyone is inquiring about health and medical benefits when they’re applying for a job in a certain company? The usual questions that rise when interviewers ask their applicant after the interview are,

“Do you have a health card for employees?”,
“How much is the reimbursable amount for outpatient medical expenses?”,
“What other medical services does the health card cover?”

Health insurance companies have saved its members thousands of dollars from costly medical expenses and doctor’s consultation fees. If health cardholders are spared from medical costs, how do medical practitioners earn from their services? In return for giving free service to patients, medical practitioners charge their services through the Medicare Physician Fee Schedule (MPFS).

Last November 1, 2018, the final draft for the MPFS 2019 was released by the Centers for Medicare & Medicaid Services (CMS) and is to be implemented at the start of the 2019 calendar year. The amendments written on the MPFS 2019 include:

  • Conversion factor per unit of certain medical services increase from $35.9996 to $36.0391. However, rates for radiology services will remain at its 2018 price, while there will be a decrease in rate for nuclear medicine, radiation oncology and radiation therapy centers.
  • Home visits to patients are no longer required to verify medical service necessity.
  • Medical practitioners no longer need re-enter a patient’s information if the patient already has previous records. Only updated information gathered during the patient’s assessment are input.
  • Consideration of the patient’s current residence as reference for the number of units/points charged for their acquired medical service instead of their originating address.
  • Small practice bonus increased to six points.

Pros

  • The increase in conversion factor per unit will let medical practitioners, whether big or small, earn slightly bigger through this healthcare payment. Not only will hospitals offering a wide variety of medical services will benefit from this price increase, but small clinics as well that meet at least two criteria in the low-threshold of MIPS.
  • Eliminating home visits for verification of the patient’s medical need lessens the admin tasks of medical practitioners so they can focus in processing data and providing needed medical services.
  • Updating only of an established patient’s information lessened the task of medical practitioners.
  • If patient is currently residing in a state that has higher units/points allocated for a certain medical service compared to their hometown, the medical team will earn more.

You can join our upcoming live webinar on Medicare Physician Fee Schedule. For more detail you can click on below link.

Medicare Physician Fee Schedule(MPFS) Final Updates for 2019

Cons

  • Codes for x-ray and breast MRs did not increase in value. However, these are one of the most common services availed in hospitals and clinics. Stakeholders are of these medical institutions are greatly dismayed.
  • Each service is entitled to a certain code. With technology fusing with the medical institution’s management system, these codes still need to be tested and assessed for a year. If codes are input wrongly during this period, the medicare payment given to the medical practitioner will follow whatever the system has processed.

The Medicare Payment Fee Schedule 2019 still has amendments to release to the public in the coming weeks. CMS admitted that 2019 is still a testing period of the G-codes (coding system for medical services rendered). The glitches that will be seen this year will be used to furnish the coding system for a more accurate healthcare payment of healthcare beneficiaries and medical practitioners.

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Have you ever wondered why everyone is inquiring about health and medical benefits when they’re applying for a job in a certain company? The usual questions that rise when ...
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