September 13, 2018

ACR Submits Comments on 2019 MPFS Proposed Rule

The American College of Radiology (ACR) commented on numerous issues and made specific recommendations in a September 10, 2018 letter to the Centers for Medicare and Medicaid Services (CMS) concerning the 2019 Medicare Physician Fee Schedule (MPFS) proposed rule and proposed changes to the Quality Payment Program (QPP).

The ACR supported CMS’ proposal to move forward with the January 1, 2020 implementation of the appropriate use criteria (AUC) program for advanced diagnostic imaging services using a series of G-codes and modifiers for claims processing. The College continues to support the program beginning with a one year “operations and testing period” where there will be no penalties for incorrect reporting. The ACR believes unique consultation identifiers (UCIs) would make the program less administratively burdensome and more robust, but it recognizes the challenges CMS faces and is committed to working with the Agency toward use of UCIs in the future. The ACR also supported CMS’ proposal to reduce burden by allowing office personnel to perform the AUC consultation, provided that the authorized personnel have clinical backgrounds (e.g., nurses, physician assistants, medical assistants).

In its comments, the ACR opposed a CMS proposal to update the direct practice expense inputs for its Practice Expense Database using information obtained StrategyGen. The College recommended that CMS abandon or delay these updates and to continue to work with stakeholders on updates to ensure the database’s accuracy. The ACR’s opposition is based on concerns about transparency, data source validity, the chosen methodology and inherent bias in the update proposal.

The ACR also commented on many items in the QPP portion of the 2019 MPFS proposed rule. The College supported maintaining the small practice bonus, which will change from five points added to the final score to three points added to the quality category score. It backed the proposal to consolidate the determination periods for low-volume threshold, non-patient facing status, small practice status, and hospital-based and ASC-based determinations into the same 24-month assessment period. The ACR also supported maintaining the data completeness requirement for quality measures at 60 percent while also maintaining bonus points for submitting additional high priority quality measures.

The ACR opposed proposed QPP rules changes that would remove two MIPS quality measures: #359, “Utilization of a Standardized Nomenclature for CT Imaging Description,” and #363, “Search for Prior CT Studies through a Secure, Authorized, Media-Free, Shared Archive.” The ACR also opposed CMS’s proposal for designating measures with a performance rate of >98% as “extremely topped out” and proposing them for removal in the next program year rather than allowing the standard 3-year topped out measure lifecycle.

Also relating to proposed QPP rules changes, the College suggested that CMS improve the Cost category’s attribution of the Medicare Spending per Beneficiary (MSPB) measure, because many radiologists are currently attributed patients under MSPB. Additionally, the ACR supported the inclusion of the on-campus outpatient hospital code (POS code 22) in the determination of facility-based individuals, but it strongly suggested to also include off-campus outpatient hospitals (POS code 19).

The comment letter also addressed the following topics:

  • Determination of Practice Expense (PE) Relative Value Units (RVUs)
  • Standardization of Clinical Labor Tasks
  • Breast Biopsy software (EQ370)
  • Potentially Misvalued Services
  • Valuation of Specific Codes
  • Radiologist Assistants (RA)
  • Evaluation and Management (E/M) Visits
  • Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services
  • Request for Information on Price Transparency: Improving Beneficiary Access to Provider and Supplier Charge Information

Quality Payment Program

  • Small Practice Bonus
  • Identifying Merit-Based Incentive Payment System (MIPS) Eligible Clinicians (EC)
  • MIPS Determination Period
  • Facility-Based Measurement
  • Performance Period
  • MIPS: Quality Performance Category
  • MIPS: Improvement Activity (IA) Performance Category
  • Final Score Methodology
  • MIPS: Qualified Clinical Data Registry (QCDR)
  • MIPS: Promoting Interoperability Performance Category
  • MIPS: Cost Performance Category
  • Advanced Alternative Payment Models (APMs)

For questions on the 2019 MPFS proposed rule or the ACR comments on the rule, please contact Katie Keysor at