Five Reimbursement Trends For 2019


By Todd Shryock

This year could prove to be a challenging year for physicians who aren’t attuned to the latest industry trends in reimbursement. Here are five things doctors need to know.

1. MIPS is here to stay

MIPS isn't going away, and its effect on practices will continue to grow. Payment adjustments-- bonuses and penalties applied depending on performance- are scheduled to increase to 7% in 2021 and 9 percents in 2022.

The 2021 figures are determined by how physicians perform this year, so its important to start focusing on MIPS now to avoid financial surprises later.

2. Size matters

Small practices are still at a disadvantage in reimbursement negotiations, which is nothing new. The largest portion of reimbursements go to those with the most leverage- hospitals, health systems, and large physicians groups.

Small practices get whatever is left. As industry consolidation continues, the big players will continue to demand a bigger piece of the financial pie, so fee-for-service payments will be flat or decline.

3. Value is the goal

Value-based contracts offer the best returns. Physicians who have the data to prove they are improving outcomes have the most appeal to insurers. Fee-for-service isn't completely going away, but it's becomings less preferred by carriers. Expect more contracts to have a greater emphasis on value-based care, with a push toward models like the Patient Centered Medical Home.

4. Telehealth pays off

Virtual check-ins are now reimbursable by Medicare. Doctors can now get paid for some evaluations done over the phone or internet, allowing for reimbursement for common communications with patients. Private payers may also start paying for telehealth services, but physicians should check with each insurer to see what they will cover.

5. Existing codes boost revenue

Transitional care management (TCM) and chronic care management (CCM) are both good codes to focus on in 2019 to boost revenue. Avoid Common mistakes such as not documenting patient discharges dates or not noting phone calls within the 24-hours of discharge. Also make sure to take advantage of billing for the Medicare annual wellness visit. This can often be done at the same time as a chronic care visit.


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    • Editor-in Chief:
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      Lin Takahashi
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      Ronald Harvinger
      Lisa Andonis

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