CMS released the MPFS on Nov. 1, ending months of turmoil.
The Centers for Medicaid & Medicare Services (CMS) released the final rule on the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP) on Nov. 1. The 2,378-page document is available in the Federal Register. This marks the end of a tumultuous few months for the medical community, since the proposal was released in July.
“The historic reforms CMS finalized today move us closer to a healthcare system that delivers better care for Americans at lower cost,” said Alex Azar, the U.S. Department of Health and Human Services (HHS) Secretary.
“Today’s rule finalizes dramatic improvements for clinicians and patients and reflects extensive input from the medical community,” added CMS Administrator Seema Verma. According to Verma, the rule will address onerous documentation requirements, allowing physicians to spend more time with their patients, and also will focus on physician burnout.
The CMS press release on this topic touts the rule as the first attempt from the agency to bring sweeping changes to evaluation and management (E&M) services, which have not been updated in 20 years. The release also mentions CMS’s attempt to reimburse physicians for technology-based virtual care, President Trump’s commitment to lowering prescription drug costs, and a major overhaul to electronic health record (EHR) requirements to promote inter-operability.
On the same evening as the press release’s distribution, an American Medical Association (AMA) press release applauded CMS for addressing the problem of regulatory burdens on physicians, especially eliminating the need to re-document certain redundant information during follow-up visits. AMA also supported CMS for delaying the proposed collapsing of E&M codes.
If you had read my post immediately following the release of the proposal back in August, I voiced concerns regarding having a single code for follow-up visits, as well as about lifting the documentation requirements. These two moves would put geriatricians, and those working in similar specialties that tend to spend a lot of time with patients during office visits, at a huge disadvantage. It also will lead to the likelihood of increased fraud and non-medically necessary visits.
Medical societies worked day and night to register their comments before the Sept. 10 deadline. Most of them opposed immediate adoption of the proposal to collapse the E&M codes, so CMS granted them their wish; this will not be finalized until 2021.
This rule does lift the redundant requirements for attending physician re-writing information that was already collected and entered by office staff or by residents or fellows. The rule also eliminates the requirement of documenting medical necessity of home visits in lieu of office visits.
The final 2019 MPFS conversion factor is $36.04, which is a small increase from the 2018 value of $35.99.
The rule also finalizes two new codes for brief communication technology-based service and remote evaluation of recorded video and/or images.
On the Accountable Care Organization (ACO) side of things, the rule implements a voluntary six-month extension for existing ACOs, as well as allows attribution of patients that see a nurse practitioner, physician assistant, certified nurse specialist, or a physician with a specialty not associated with previous assignment methodology.
On the Quality Payment Program (QPP) side of things, the major changes are on advancing care information (ACI) as it morphs into promoting interoperability (PI). There is also an ongoing attempt to incentivize small practices to report into the Merit-Based Incentive Payment System (MIPS).
In conclusion, the jury is still out in the broader physician community as to whether they like this new rule. Social media is lighting up with knee-jerk reactions, and so far, the “yeas” and “nays” are running neck-and-neck.
Increasing pressure to improve emergency department (ED) throughput has led many hospitals to adopt workflows in which ED physicians initiate inpatient or outpatient observation orders
The Centers for Medicare & Medicaid Services (CMS) continues to expand its focus on hospital readmissions in the FY 2027 IPPS (Inpatient Prospective Payment System)
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Happy HIP Week! Sign up to win free access to our 2026 Coding Clinic Update Webcast Series! Click here to learn more →
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
