2018 proposed rule

In July, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2018 Medicare Fee Schedule. As part of a statutory across-the-board reduction in payments, the rule proposes an overall 1% decrease to dermatology payments.

Download a snapshot of proposed payment changes to dermatology codes in 2018.

Within the proposed rule, CMS solicits ideas for making the health care delivery system less bureaucratic and complex for physicians, providers and patients. The American Academy of Dermatology Association (AADA) has already engaged with the Administration in this area, strongly advocating for relief for physicians, and appreciates that CMS has been responsive to our requests.

For example, the rule proposes that the current Physician Quality Reporting System (PQRS) program only require reporting of 6 measures down from the current program policy of 9 measures. CMS also proposes reducing the penalties for not meeting minimum quality reporting requirements under the value-based modifier, and not penalizing physician groups and solo practitioners who meet quality reporting requirements under quality-tiering for the last year of the program.

The 2018 proposed fee schedule includes a number of other important items for dermatology. CMS proposes:

  • New values for new and existing photodynamic therapy codes to allow for the identification of physician time versus staff time. The AADA will be working to ensure that the new values are appropriate.
  • Added codes for telehealth services and the proposed elimination of the required reporting of the telehealth modifier to reduce the administrative burden on physicians.
  • Changing the guidelines for evaluation and management codes, and asking providers to report the patient relationship modifiers on their Medicare claims starting in 2018.
  • Cutting payment for certain off-campus provider-based hospital department services by 50% (the AADA will be carefully evaluating the impact).
  • The proposed rule does not include information regarding the new biopsy code values that were reviewed in 2017. Those are expected to be published in 2018.

AADA staff continues to analyze the rule, will be publishing other analyses, and plans to submit comments to CMS by September 11, 2017.

For a fact sheet on the proposed rule, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-07-13-2.html