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Tags Posts tagged with "MPFS"

MPFS

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The Centers for Medicare and Medicaid Services (CMS) published the calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) in the Federal Register for November 18, 2022. Some of the key provisions contained in the final rule include (and are effective on January 1, 2023):

Medicare Telehealth Services

  • Addition of new HCPCS codes to the list of Medicare telehealth services on a Category 1 basis.
  • Implementation of the 151-day extensions of Medicare telehealth flexibilities, including allowing telehealth services to be provided in any geographic area and in any originating site setting.
  • Permission for physical therapists, occupational therapists, speech-language pathologists, and audiologists to provide telehealth services.
  • Listing of codes added to the telehealth services list are here.

Evaluation & Management (E&M) Visits

  • For CY 2023, CMS finalized changes for “Other E/M” visits that parallel the changes that were made in recent years for office/outpatient E/M visit coding and payment. Other E/M visits include hospital inpatient, hospital observation, emergency department, nursing facility, home services, residence services, and cognitive impairment assessment visits.

Behavioral Health

  • Proposal finalized to create a new HCPCS code (G0323) describing General Behavioral Health Integration performed by clinical psychologists or clinical social workers to account for monthly care integration where the mental health services provided are serving as the focal point of care integration.

Chronic Pain Management

  • Finalized a CY 2023 proposal to create two new G codes (G3002 and G3003) performed by physicians and other qualified health professionals describing monthly CPM for payment starting January 1, 2023.

Opioid Treatment Programs (OTPs)

  • CMS finalized the proposal to allow the OTP intake add-on code provided via 2-way, interactive, audio-video technology when billing for the initiation of treatment with buprenorphine using audio-video technology to start treatment with buprenorphine as authorized by the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) at the time the service is provided.
  • CMS also finalized the proposal to permit the use of 2-way, interactive, audio-only technology to start treatment with buprenorphine in cases where audio-video technology isn’t available to the patient and all other applicable requirements are met.

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On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released the proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2023. In this proposed rule, CMS is proposing an approximately 4 percent reduction to the base payment factor for all services for 2023. The specific level of adjustment providers may see will depend on changes CMS finalizes to other factors. CMS is also proposing to expand the list of codes that can be provided via telehealth through 2023 to include some therapy codes. Modifications to the Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS), to allow for additional pathways for participation for certain specialties is also being proposed. The proposed rule will appear in the July 29 Federal Register.

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The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule. Some of the key provisions contained in this final rule include:

Telehealth Services

CMS finalized a policy to allow for Category 3 telehealth services to be available to providers through December 31, 2023. Category 3 telehealth services are those services CMS has added temporarily to the telehealth list due to the public health emergency (PHE) but wishes to consider for permanent addition to the telehealth list. Presently, many occupational and physical therapy services are on the Category 3 list, with some exceptions. However, CMS has not yet added any speech-language service codes to the Category 3 list, so their availability will cease at the end of the PHE. The current list of available telehealth codes is available here.

Therapy Services

CMS made final modifications to its policy for implementing a 15 percent payment reduction for outpatient therapy services provided in part by a therapy assistant, effective January 1, 2022. As previously finalized, any billed unit of service in which a therapy assistant independently provided more than 10 percent of the minutes of service must include a claim modifier and will be subject to the payment reduction. In this final rule, CMS slightly loosened the requirements, allowing providers to forgo appending the modifier for “remaining units” when the therapist had provided at least 8 minutes of the remaining unit, regardless of any additional minutes provided by the therapy assistant. CMS has provided numerous billing scenarios in the final rule to help explain the steps providers should take to determine when the modifier should be used. This guidance will be posted on CMS’ website.

Billing of Shared Services With a Physician Assistant (PA) or Nurse Practitioner

CMS finalized its proposed policy regarding the billing of services when both a physician and non-physician practitioner (NPP), such as a physician assistant (PA) or nurse practitioner (NP), share in the provision of a service. CMS will require the practitioner who performed the majority of the minutes relating to the service to bill for the service. Therefore, when an NPP provides more than 50 percent of the time for a given service, the NPP must bill for the service, and payment will be made at the lower applicable rate for that billed code. This policy applies to all Evaluation and Management (E/M) services provided in institutional settings, including hospitals.

CY 2022 PFS Rate-Setting and Conversion Factor

CMS finalized a series of standard technical proposals involving practice expense, including standard rate-setting refinements, the implementation of the fourth year of the market-based supply and equipment pricing update, and changes to the practice expense for many services associated with the update to clinical labor pricing. CMS finalized their proposal to update the clinical labor rates for CY 2022 through the addition of a four-year transition period as requested by public commenters.

The final rule will be published in the November 19, 2021 Federal Register.

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On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) final rule. The final rule includes updates to payment policies, payment rates, and quality program provisions for services effective on or after January 1, 2020.

Some of the provisions included in the final rule:

Medicare Telehealth Services – The following HCPCS codes are being added to the list of telehealth services: G2086, G2087, and G2088, which describe a bundled episode of care for treatment of opioid use disorders.

Evaluation & Management (E/M) Services – CMS is mirroring the E/M changes that were adopted by the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel for office/outpatient E/M visits.

Physician Supervision Requirements for Physician Assistants (PAs) – The regulation has been updated on physician supervision of PAs to provide them with greater flexibility to practice more broadly in accordance with state law and state scope of practice.

Review and Verification of Medical Record Documentation – In order to reduce burden, CMS finalized broad modifications to the documentation policy so that physicians, physician assistants, and advanced practice registered nurses (APRNs – nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists) can review and verify (sign and date), rather than re-documenting, notes made in the medical record by other physicians, residents, medical, physician assistants, and APRN students, nurses, or other members of the medical team.

Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs – CMS is implementing a new Medicare Part B benefit for opioid use disorder (OUD) treatment services, including medications for medication-assisted treatment (MAT), furnished by opioid treatment programs (OTP).

Counseling and Therapy Services – Finalized a policy to allow counseling and therapy services described in the bundled payments, to be furnished via two-way interactive audio-video communication technology as clinically appropriate.

Beneficiary Copayment – There will be a zero beneficiary copayment for 2020.

The final rule will be published in the November 12, 2019 Federal Register.

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On July 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released two proposed payment rules, both of which include Requests for Information (RFI):

Hospital Outpatient Prospective Payment System (OPPS)
This proposed rule updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed rule is one of several for 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in health care; and promote transparency, flexibility, and innovation in the delivery of care. The OPPS and ASC payment system are updated annually to include changes to payment policies, payment rates, and quality provisions for those Medicare patients who receive care at hospital outpatient departments or receive care at surgical centers. Among the provisions in this rule, CMS is proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program. The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals (CAHs). In addition, CMS is releasing within the proposed rule a Request for Information (RFI) to welcome continued feedback on positive solutions to better achieve transparency, flexibility, program simplification and innovation in the Medicare program. CMS is also soliciting ideas for regulatory, sub-regulatory, policy, practice, and procedural changes to better accomplish these goals. Ideas could include recommendations regarding payment system re-design; elimination or streamlining of reporting; monitoring and documentation requirements; operational flexibility; and feedback mechanisms and data sharing that would enhance patient care, support the doctor-patient relationship in care delivery, and facilitate patient-centered care within outpatient stays at hospitals and services performed at ambulatory surgical centers. Additional information available to members includes a fact sheet. The proposed rule will be published in the Federal Register on July 20, 2017. Comments on this proposed rule will be accepted until September 11, 2017.
Medicare Physician Fee Schedule (MPFS)
This proposed rule updates the Medicare payment, policies and quality provisions for physicians and other clinicians who treat Medicare patients in calendar year (CY) 2018. The proposed rule seeks public input via a request for information (RFI) on solutions to better achieve transparency, flexibility, program simplification, and innovation. CMS cites in the proposed rule its desire to start a national conversation about improving the health care delivery system; how Medicare can contribute to making the delivery system less bureaucratic and complex; and how we can reduce burden for clinicians, providers, and patients in a way that increases quality of care and decreases costs, thereby making the health care system more effective, simple, and accessible while maintaining program integrity and preventing fraud. CMS is soliciting ideas for regulatory, sub-regulatory, policy, practice, and procedural changes to better accomplish these goals. Ideas could include recommendations regarding payment system re-design; elimination or streamlining of reporting; monitoring and documentation requirements; operational flexibility; and feedback mechanisms and data sharing that would enhance patient care, support the doctor-patient relationship in care delivery, and facilitate patient-centered care. Ideas could also include recommendations regarding when and how CMS issues regulations and policies and how CMS can simplify rules and policies for beneficiaries, clinicians, providers, and suppliers. In responding to the RFI, CMS should be provided with clear and concise proposals that include data and specific examples. The proposed rule also includes provisions to better align incentives and provide clinicians with a smoother transition to a new Merit-based Incentive Payment System under the Quality Payment Program. It also encourages more fair competition between hospitals and physician practices by promoting greater payment alignment, and it would improve the payment for office-based behavioral health services that are often the therapy and counseling services used to treat opioid addiction and other substance use disorders. CMS is also proposing several modifications to the rules for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program. In addition, the proposed rule makes additional proposals to implement the Center for Medicare and Medicaid Innovation’s (CMMI) Medicare Diabetes Prevention Program expanded model starting in 2018. CMS released a fact sheet to provide more detailed information. The proposed rule will be published in the Federal Register on July 21, 2017. Comments on this proposed rule will be accepted until September 11, 2017.

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