Medicare issues final fee schedule and 2018 Quality Payment Program Rules

On November 2, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for the 2018 Physician Fee Schedule (PFS) and final rule with comment period for the Quality Payment Program (QPP). 

The overall update to payments under the PFS based on the finalized CY 2018 rates will be +0.41 percent. This update reflects the +0.50 percent update established under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, reduced by 0.09 percent, due to the misvalued code target recapture amount, required under the Achieving a Better Life Experience (ABLE) Act of 2014.  After applying these adjustments, and the budget neutrality adjustment to account for changes in RVUs, all required by law, the final 2018 PFS conversion factor is $35.99, an increase to the 2017 PFS conversion factor of $35.89. 

CMS is also expanding the types of services reimbursed when delivered via telehealth, reducing the administrative burden of billing for telehealth services, expanding coverage for “biosimilars,” and expanding access to the Medicare Diabetes Prevention Program. Click here for a CMS fact sheet on PFS, and here for an AMA fact sheet

The QPP final rule includes policies intended to reduce the burden and support clinicians in small and rural practices to successfully participate in this program. In addition, the rule decreases the number of clinicians required to participate by excluding individual MIPS eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries.  The final rule provides additional detail on clinician participation in Advanced Alternative Payment Models (APMs). Clinicians can receive credit for payment bonuses through participation in these APMs.  Click here for a CMS fact sheet and here for an AMA fact sheet. 

Several upcoming webinars will provide more information about the Year 2 final rule and requirements, including a November 14th CMS webinar and a webinar hosted on November 30th by the Medicare Learning Network.  For more information, click here and here.  Also visit the New England Quality Payment Program Support Center at

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