Important Provisions Under The 2018 Medicare Physician Fee Schedule Regarding Patient Payment

When it comes to healthcare in the United States, Medicare plays a crucial role in providing coverage for millions of Americans. The Medicare Physician Fee Schedule (MPFS) is a list of payment rates for services provided by physicians and other healthcare professionals under Medicare Part B. In 2018, several updates were made to the MPFS, including provisions related to patient payment. Let's take a closer look at what these provisions entail and how they may impact patients.

Key Changes in the 2018 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) updates the MPFS annually to reflect changes in the cost of providing healthcare services. In 2018, some key changes were made to the Fee Schedule that directly impact how patients are billed for services provided by healthcare professionals. These changes include:

1. Updates to payment rates for specific services
2. Changes to Reimbursement policies
3. Updates to coding and documentation requirements

Payment Rates for Specific Services

One of the most significant changes in the 2018 Medicare Physician Fee Schedule is the update to payment rates for specific services. The CMS adjusts payment rates based on factors such as changes in the relative value units (RVUs) assigned to each service, changes in the geographic practice cost index (GPCI), and updates to the conversion factor used to calculate payments.

Reimbursement Policies

In addition to changes in payment rates, the 2018 MPFS also included updates to Reimbursement policies that may impact patient payment. For example, the CMS may have implemented new policies related to the billing of telehealth services, accountable care organizations (ACOs), or value-based payment models that could affect how patients are billed for services provided by healthcare professionals.

Coding and Documentation Requirements

Another key aspect of the 2018 Medicare Physician Fee Schedule is updates to coding and documentation requirements. The CMS may have revised coding guidelines for certain services, which could impact how healthcare professionals bill for their services. Additionally, the CMS may have implemented new documentation requirements that must be met in order to receive payment for services provided to Medicare beneficiaries.

Implications for Patient Payment

So, what do these changes in the 2018 Medicare Physician Fee Schedule mean for patient payment? Here are some key implications that patients should be aware of:

1. Changes in payment rates could impact out-of-pocket costs for patients
2. New Reimbursement policies may affect which services are covered by Medicare
3. Updates to coding and documentation requirements could result in more stringent billing practices

Changes in Payment Rates

One of the most direct ways that patients may be impacted by the changes in the 2018 MPFS is through changes in payment rates for specific services. If the CMS has adjusted payment rates downward for certain services, patients may be required to pay more out-of-pocket for those services. Conversely, if payment rates have increased, patients may see a decrease in their out-of-pocket costs.

Reimbursement Policies

Changes to Reimbursement policies can also have a significant impact on patient payment. For example, if the CMS has implemented new policies that restrict coverage for certain services, patients may be required to pay for those services themselves. On the other hand, if new policies expand coverage for certain services, patients may see a decrease in their out-of-pocket costs.

Coding and Documentation Requirements

The updates to coding and documentation requirements in the 2018 MPFS could also impact patient payment. If healthcare professionals are now required to meet stricter documentation requirements in order to receive payment for services provided to Medicare beneficiaries, patients may experience delays in receiving care or may be billed for services that were previously covered. Additionally, changes to coding guidelines could result in higher out-of-pocket costs for patients if certain services are now billed at a higher rate.

Conclusion

In conclusion, the 2018 Medicare Physician Fee Schedule includes several provisions related to patient payment that may impact how patients are billed for services provided by healthcare professionals. Changes in payment rates, Reimbursement policies, and coding and documentation requirements can all have a significant impact on patient payment and out-of-pocket costs. Patients should be aware of these changes and how they may affect their healthcare coverage under Medicare. For more information on the 2018 MPFS and its implications for patient payment, consult with your healthcare provider or contact Medicare directly.

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