Tag: PFS

CMS Finalizes Rate Cuts in 2023 Medicare Physician Fee Schedule

Member News

The Centers for Medicare & Medicaid Services (CMS) recently released the 2023 Medicare Physician Fee Schedule (PFS) final rule, effective Jan. 1, 2023. The rule reduces the PFS conversion factor by $1.55 (4.7%) to $33.06 in a calendar year (CY) 2023 from $34.61 in CY 2022, which reflects a required statutory update of 0% and the expiration of the one-year Congress-approved 3% increase in PFS payments for CY 2022. The finalized rule also includes changes in policies for telehealth, opioid use disorder, dental services, and the Medicare Shared Savings Program (MSSP).

The CMS finalized:

  • Expanding the telehealth category 3 codes list and extend coverage through Dec. 31, 2023
  • Modifying opioid treatment program payment rates that will increase overall payments for medication-assisted treatment and other treatments for opioid use disorder
  • Clarified that Medicare Fee-For-Service (FFS) payment for dental services when it is an integral part of treatment, such as dental exams and necessary treatment before organ transplants, cardiac valve replacements and valvuloplasty procedures
  • Making several changes to increase participation in the MSSP, including updates to benchmarks to sustain long-term participation and reduce costs. The CMS also updated quality measurement policies, including a new healthy equity adjustment that will award bonus points to accountable care organizations serving high proportions of underserved beneficiaries

Members with questions and feedback should contact Renée Smiddy at the MHA.

CMS Proposes Rate Cuts in 2023 Medicare Physician Fee Schedule

Member News

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule for physician fee schedule (PFS) payments and other Medicare Part B issues, effective Jan. 1, 2023. The rule proposes to reduce the PFS conversion factor by $1.53 (4.6%) to $33.08 in calendar year (CY) 2023, compared to $34.61 in CY 2022. The proposed rule also includes changes in policies for telehealth, opioid use disorder, dental services, and the Medicare Shared Savings Program (MSSP).

The CMS proposes to:

  • Reduce the conversion factor to $33.08, which reflects a required statutory update of 0% and the expiration of the one-year Congress-approved 3% increase in PFS payments for CY 2022.
  • Delay indefinitely the payment penalty period of the Appropriate Use Criteria. The CMS is unable to forecast when the payment penalty phase will begin again.
  • Expand the list of telehealth category 3 codes and extend coverage through Dec. 31, 2023.
  • Delay for one year (until Jan. 1, 2024) implementation of its policy to define the substantive portion of a split (or shared) visit based on the amount of time spent by the billing practitioner.
  • Make several changes to increase participation in the MSSP, including implementing longer glide paths to downside risk for accountable care organizations (ACOs) and modifying benchmarking methodology to ensure ACOs do not have to compete against their own best performance.
  • Expand behavioral health access by permitting licensed professional counselors, marriage and family therapists, and other types of practitioners to provide services, thereby creating an exception to the direct supervision requirement for “incident to” billing.

Members are encouraged to submit comments to the CMS by Sept. 7. Questions and feedback should be directed to Renée Smiddy at the MHA.

Advocacy Continues to Defend Healthcare from Harmful Federal Policies

Member News

President Joe Biden Dec. 10 signed legislation to postpone several proposed cuts in Medicare rates recently approved by Congress. The MHA and the American Hospital Association had urged lawmakers to delay the cuts that would have taken effect Jan. 1 due to the pandemic-related financial pressures healthcare providers continue to experience. Provisions in the legislation include:

  • Eliminating the 2% Medicare sequester cuts from Jan. 1 to March 31, 2022. The legislation would also reduce the cut to 1% from April 1 to June 30, 2022. Absent future legislation, the 2% cuts will take effect July 1, 2022. The package is being funded by increasing the sequester percentage in 2030.
  • Halting the 4% statutory Pay-As-You-Go (PAYGO) sequester for 2022 and adding them to the “2023 scorecard.” This will require additional advocacy with the Congress in late 2022 to eliminate these cuts again.
  • Mitigating the 3.75% payment cut to the Medicare physician fee schedule (PFS) payments finalized for calendar year 2022 by implementing a one-year 3% increase to the PFS conversion factor.
  • Delaying the Clinical Laboratory Fee Schedules cuts for one year, from Jan. 1, 2022, to Jan. 1, 2023. The requirements that certain hospital laboratories report their private payer clinical laboratory test codes, payments and volume data are also delayed.
  • Delaying implementation of the Radiation Oncology Model finalized in the 2022 Medicare outpatient prospective payment system final rule from Jan. 1, 2022, to Jan. 1, 2023.

Despite the limits on visiting Capitol Hill due to the COVID-19 pandemic, the MHA is continuing its work with the Michigan delegation using virtual connections to protect hospitals and other providers from detrimental payment cuts and other healthcare policies. Members with questions regarding payment implications should contact Vickie Kunz at the MHA, while questions regarding advocacy efforts should be addressed to Laura Appel at the MHA.