Tackling the CMS 2022 Medicare Physician Fee Rule

Physicians have a mountain of issues to deal with when running a practice, not the least of which is keeping up with regulatory requirements. One recent update is the 2022 proposed physician payment policies for Medicare. The new proposal, published on July 23rd of this year, is complex. It will undoubtedly prove cumbersome for some physicians, particularly those involved in the daily tasks of managing payments and compliance. The 2022 proposed rule includes over thirty changes to how providers can qualify as Medicare providers and bill for covered services. The task of identifying those segments of the rule affecting your practice can be daunting for physicians. The new rules will have a significant impact on group and independent practices. There are a couple of changes of which physicians need to consider carefully. Let’s look at the significant changes that could impact your practice and in what way.

Conversion Factor

Included in the policy changes is a proposal for the conversion factor. The conversion factor is the number used to convert one set of units to another by multiplying or dividing value units of service. The language regarding conversion is complex and may be confusing to some providers, but what’s clear is this: the new conversion factor will decrease reimbursements to providers. The estimated decrease in reimbursement uses measures from the previous year ($1.31). While this may seem like a slight decrease, based on volume, the impact will be significant. Mitigating this portion of the rule is a work in progress for consultants, but currently, there is no answer to this problem.

Telehealth Services

The new rule also includes provisions for telehealth services. The pandemic made clear; telehealth is needed, and for a good reason.  But the uncertainty surrounding continued modeling for telehealth has been a frequent topic for conversation around the industry. Under the rule, telehealth services placed temporarily on the list by CMS during the pandemic will continue to be covered until the end of 2023 by extension. While the expansion of telehealth services may be intuitive, reimbursement for telehealth services and who’s allowed to bill for those services has to be examined for long-term economic impact, not simply as a reaction to the pandemic.

Evaluation and Management

A split-share E/M will also see changes that will impact how practices bill for services. The term sounds more complicated than it is. A “split-share E/M” refers to a medically necessary encounter with patients whereby the physician and a “qualified (be careful here) NPP each perform a substantive portion of an EM face-to-face visit, with the same patient, on the same date of service. Under the new rule, CMS plans to change the definition to reflect the actual practice of non-physician practitioners. How will practices be impacted? The rule changes how the billing is to be performed by each professional, which visits can be billed for, and which patients can be billed. CMS has also added new documentation standards, which will undoubtedly add to the administrative tasks, many providers currently find so frustrating. This new requirement is also nit-picking, as it requires a measure of which professional performed the majority of the visit.

Some Good News

It’s not all bad for physicians and practices. The specialties in MIPS have been expanded to include non-physician professionals such as social workers and certified midwives. This move will affect the performance category, which will automatically be re-weighted to account for the change. To see a complete list of the specialties and the effects on group and individual practices, visit the CMS rule here. The proposed rule includes a post-COVID focus on some new categories of the MIPS Improvement  Activity Category. A new category includes new options focused on physician burn-out, health equity, and emergency preparedness. You can visit the proposed rule to see how it could impact your specialty.

Strategic Planning

To prepare for the proposed changes, your groups and private practices need to form a strategy to include:

• Read the rule. Nothing is more strategic than being informed.

• Submit your comments. CMS will accept comments regarding the rule until September 13th, 2021.

• Rally the troops. Identify those professionals affected by the rule, and map out how to put policies and practices in place to comply.

• Reach out to compliance specialists. You don’t have to tackle the new rules alone. Practices can alleviate some of the headaches associated with the proposed changes by hiring a consultant. Consultants have one job, keeping you compliant. You need to be able to manage your practice and address the needs of your patients. Now is the right time and the exact environment for hiring a consultant.

If you feel now is the right time to strategize, you can reach out to Chirpy Bird HIT here. 

Shereese Maynard is a compliance professional, Health IT influencer, and contributor at Chirpy Bird.