On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) issued the CY2022 Medicare Physician Fee Schedule Final Rule. The CMS finalized many policies from the July proposed rule, including the decreased conversion factor, billing for shared visits and teaching services, the continuation of telehealth services and inclusion of an ACR-led Merit-Based Incentive Payment System (MIPS) Value Pathway (MVP).
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The final rule codified the conversion factor of $33.59, which represents a 3.75% decrease from last year. This cut is due to the sunset of an across-the-board 3.75% patch that was enacted by Congress to alleviate financial strains due to the public health emergency and will expire at the end of 2021. With other organizations, the ACR is leading advocacy efforts to ask Congress to extend this patch while also averting the Medicare reimbursement cuts currently scheduled to take effect on Jan. 1, 2022.
Evaluation & Management Services
The final rule continues to operationalize the updated evaluation and management (E/M) revaluation and documentation requirements that went into effect in January 2021. The rule also finalizes requirements for billing of shared visits with non-physician providers in facility settings. Shared visits should be billed by the practitioner that provides the substantive portion of the visit or more than half the time spent in the visit. Additionally, the rule clarifies that when determining the E/M visit levels, only medical decision making for primary care providers can be used to determine the visit levels. For non-primary care specialties, the teaching physician time spent on qualifying activities can be used for visit level determination.
At the onset of the public health emergency, the CMS issued broad flexibilities for telehealth, including the site of service requirements. Last year, many of these flexibilities were included in a third category under the covered services. The final rule extends these flexibilities through 2023. The CMS will use this time to evaluate which flexibilities should be made permanent in a post-pandemic telehealth environment. The ACR will be engaging with the CMS as it continues to envision telehealth after the public health emergency.
MIPS Value Pathway
The CMS accepted the ACR-led rheumatology MIPS Value Pathway (MIPS), scheduled to begin in 2023. The MVP aims to serve as a bridge between the MIPS and alternative payment model (APM) programs to better align quality measures. The ACR is working on the specifics of this program with the CMS and will provide updates as they become available.