Last week the Centers for Medicare and Medicaid Services (CMS) proposed to update physician fee schedule rates by 0.25 percent in calendar year 2019, as required under the Medicare Access and CHIP Reauthorization Act of 2015. After this update and the budget-neutrality adjustment required by law, the proposed 2019 PFS conversion factor is $36.05, an increase from $35.99. CMS proposes to continue to allow nonexcepted provider-based departments to bill for nonexcepted services on the institutional claim and would maintain payment for nonexcepted services at 40% of the outpatient prospective payment system amount for CY 2019. Section 603 requires that, except for dedicated emergency department services, services furnished in off-campus provider-based departments that began billing under the OPPS on or after Nov. 2, 2015 no longer be paid under the OPPS, but under another applicable Part B payment system. In addition, the rule proposes updates to the Quality Payment Program to align the Promoting Interoperability performance category requirements with the Promoting Interoperability Program proposed for hospitals in the inpatient prospective payment system rule, and to increase the weight of the Merit-based Incentive Payment System cost category to 15% while lowering the weight of the quality category to 45 percent.