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Medicare Proposal for 2023 Reimbursement Released

On July 7, the Centers for Medicare & Medicaid Services released the annual proposal for Medicare reimbursement for the coming year. In the absence of Congressional intervention, the payment rate for physicians will decline by 4.4% in 2023 based on the proposed conversion factor of $33.08, a decrease of $1.53 from the current factor of $34.61.

The recent ruling proposed other key changes to physician reimbursement in 2023, to include:

  • Broad application of office-based E/M rules

CMS is employing the American Medical Association’s extensive revisions to all E/M codes, which include eliminating the use of history and exam to determine code levels for inpatient, observation, and “other” E/M services. See this link for the AMA’s changes to E/M codes effective January 1, 2023.

  • Extension of key public health emergency (PHE) relaxations

Under a separate decree, the PHE was extended until October 13. The proposed rule is paying for certain services for an additional 151 days (five months) following the conclusion of the PHE. This includes paying for telemedicine services with the “originating” site as the patient’s home and permitting the services to be furnished in any geographic area. In addition, audio-only (telephone) visits will remain covered (with new CPT modifier - 93) and Federally Qualified Health Centers (FQHCs) will be able to continue offering telehealth services during this five-month period.

  • Expansion of non-physician services

Licensed professional counselors and other behavioral health practitioners can practice under general supervision, with additional payment allowances for clinical psychologists and social workers on care teams as core components of CMS’ new behavioral health strategy. Additionally, Medicare beneficiaries are allowed to access audiologists directly for hearing aids and more with new CPT code, GAUDX.

  • Expansion of colon cancer screening

CMS is decreasing the age requirement for the study to 45 (from 50, for certain screening tests) and eliminating beneficiaries’ cost-sharing on a follow-up colonoscopy to an at-home test.

  • Revisiting global periods

CMS questioned the use of global periods for surgeries nearly a decade ago and is again seeking feedback about the efficacy of global periods.

  • Initiating payment for chronic pain

The agency is expanding coverage to chronic pain management and treatment services with new CPT codes and accompanying reimbursement. The expanded coverage is proposed to extend to FQHCs and Rural Health Clinic.

The 2,066-page proposed rule is viewable at here.  You can also review CMS’ summary. Stay tuned for the final rule, which is normally issued the first week of November. Although the July 7 ruling is a proposal, it is often a blueprint for the coming year.

About The Author

Elizabeth Woodcock is the founder and principal of Woodcock & Associates. She has focused on medical practice operations and revenue cycle management for more than 25 years. She has led educational sessions for a multitude of national professional associations and specialty societies, and consulted for clients as diverse as a solo orthopaedic surgeon in rural Georgia to the Mayo Clinic. She is author or co-author of 17 best-selling practice management books, to include Mastering Patient Flow and The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a Bachelor of Arts from Duke University, she completed a Master of Business Administration in healthcare management from The Wharton School of Business of the University of Pennsylvania. She is currently a doctoral student at the Bloomberg School of Public Health of Johns Hopkins University.

The contents of The Sentinel are intended for educational/informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and/or change over time.

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