Finalized Medicare Payment and Reporting Changes

On November 1^st, the Centers for Medicare and Medicaid Services (CMS) released their final Medicare Physician Fee Schedule (PFS). This new and final 2023 ruling affects not only Medicare payout to physicians, but the Merit-based Incentive Payment System (MIPS), and the alternative payment model (APM) as well.

“Anesthesia Conversion Factor, work Relative Value Units (RVUs) for several pain medicine codes, and policy updates for the 2023 QPP performance year will be effective January 1, 2023. Absent Congressional action, all physician practices – including anesthesiologists and their groups – will face significant Medicare payments cuts next year,” (American Society of Anesthesiologists). Anesthesia being the most affected, with a 4.47% decrease from the rates in the current year of 2022. This decrease may seem small, but it will make a big impact as the year goes on.

With this finalized ruling, we will also see extended telehealth provisions that was put in place due to the public health emergency. Once the PHE is declared as finished, to ensure a smooth transition, they have chosen to extend the provisions by 151 days – “including allowing payment for RHCs and FQHCs for furnishing telehealth services as distant site practitioners (though note that mental health visits can be furnished virtually on a permanent basis) under the payment methodology established for the PHE, allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, and allowing certain services to be furnished via audio-only telecommunications systems,” (CMS.gov).

“MGMA submitted detailed comments in response to the proposed rule in September. Be on the lookout for a more detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP) in the coming weeks,” (MGMA Regulatory Alert).

For more information, and to keep up to date on policy changes, please follow the following links or sources:

PFS Fact Sheet, FAQ

Sources:
“Fact Sheet Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule.” CMS, https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule?utm_source=email&utm_medium=marketo&utm_campaign=gov-washingtonconnection-oct-2022-regalert1031&mkt_tok=MTQ0LUFNSi02MzkAAAGH1B6DQSAYQZNXcZCy3E_z53VOq5t7ZbNvsM5maFQZnsPwXfV3TSCRCRJOnFGeC08dWNFDKMtCP8mJhXaa8C_S9kuhEONhijo_bV39AX_9cQ.

“CMS Provides Little Relief for Anesthesia Groups in Release of 2023 Payment Rules.” American Society of Anesthesiologists (ASA), https://www.asahq.org/advocacy-and-asapac/fda-and-washington-alerts/washington-alerts/2022/11/cms-provides-little-relief-for-anesthesia-groups-in-release-of-2023-payment-rules#:~:text=CMS%20has%20finalized%20significant%20cuts,2022%20anesthesia%20CF%20of%20%2421.5623.