What is the CMS Final Rule for CY 2022| Physician Fee Schedule
The Center for Medicare & Medicaid Services (CMS) has issued a final update on payments for 2022 for all healthcare professionals, including physicians. That is the final rule of the medical fee schedule and quality payment program. It was held on November 2, 2021. In particular, the CMS has issued a final rule in response to comments made by AAMC and other agencies and authorities. According to this rule, for 2022,
- The latest update on payment fees for health services
- Expanding telehealth facilities for mental health
- Policy changes to quality payment programs
- Vaccine administration
- Critical care services
- Teaching includes many other updates, such as new policies regarding physicians.
Accordingly, analysts said that the 2022 Medicare & Medicaid Services conversion factor would be 3.85% or less from 34.8931 to 33.5983 from this year (2021) to next year. Also, in addition to the CF reduction, there will be several indirect cuts in payments for active physicians through other procedures from the first day of 2022. This cut is approximately 9.75% on a net basis.
Split / Shared, (E / M) Visits- evaluation and management
The Final Rule for CY 2022 PFS defines the Split / Shared Evaluation and Management (E / M) as “E / M attendance facilitated by the same team physician and NPP in the facility setting.” The medical professional, who provides a significant portion of the visit, bills for a holiday.
Accordingly, the average considerable share in 2022 will be determined based on several factors. First, more than half of the time is based on history, medical decision-making, physical examination, etc. Accordingly, the doctor who provides a significant portion of the visit must bill the visit. By 2023, a substantial portion of that visit is defined as more than half of the total time spent.
Also, the person providing the vital part should sign the medical report and make a date. For that, the documents in the medical information should first identify the two persons who visited. The new rule also allows new patients to record initial and subsequent visits, split (or shared) attendance for more comprehensive services.
It’s to inform policy and keep all programs running. It is necessary to identify the persons who have joined those services, document them in medical records, and modify the claims.
Critical care services
The latest CMS rule states that if a resident participates in the provision of a service, you can include only the time spent by the professional in determining the level of E / M attendance in the absence of critical care. And if the professional notes that they provided, urgent primary care, acute care may be paid by the same healthcare professional or another professional in the same specialty on the same day as another E / M return.
So, in addition to operations with a global surgical duration, there is the opportunity to pay for critical care separately. That’s when essential care services are not involved in the surgery.
When the definition of critical therapies is met, that is, when the physician’s full attention to the patient is required, pre-and post-surgical treatment payments may be made in addition to the procedure. For that, there should be no particular connection to critical care.
Medical fee schedule
Healthcare professionals have been paying their bills under PFS for many years now. There are several changes regarding CMS’s latest standard rate setting and pricing updates. They ran a four-year transition period to collect data relevant to the change. Including those changes, CMS has adjusted the PFS ratio for CY 2022.
Accordingly, the 2021 temporary CY 3.75 pay increase expired. Therefore, the PFS conversion factor for CY 2022 is $ 33.59. ACCORDING TO CMS’S LATEST RULE RATE, the CY 2022 PFS conversion factor is down from $ 34.89 to $ 1.30.
Telehealth services for mental health
Add Medicare telehealth services to the existing temporary telehealth services by the end of CY 2023. In addition, CMS plans to implement a broader range of telehealth services that diagnose, treat, and evaluate psychiatric disorders.
Accordingly, CMS has also extended specific mental and cardiac rehabilitation codes by December 31, 2023.CMS seeks to add the beneficiary’s home as a start-up site for telehealth facilities, including identifying mental illnesses, by removing geographical boundaries about CAA 123.
CMS limits the ability to provide only audio when using telehealth by professionals who can give two-way audio/video communication. Also, due to certain conditions, home-based patients may use two-way audio/video technology at their discretion and need when using telehealth to receive treatment for mental illness.
The CMS Final Rule also states that mental health services include medication and treatment for ailments. Personal visits are required six months before and 12 months after the initial telehealth service.
Quality payment program
The merit-based incentive paying method (MIPS) for the 2022 rule indicates that the transition to value-added (MVPs) won’t occur until the 2023 performance year. Accordingly, in 2023, seven measurement options will come into effect. These 7 (MVPs) are stroke care and prevention, rheumatology, chronic diseases, heart disease, emergency treatment, anesthesia and lower extremity repair.
Starting in the 2023 Performance Year, the APM Performance Path allows a group of professionals to report as a subgroup. That is, for physicians with MIPS qualifications from CMS. They ended up with a CMS proposal to further extend the CMS web interface. As a quality reporting option for registered teams or APMs for the 2022 Performance Period.
Increases quality by 30% for individuals, groups or small groups engaged in traditional MIPS reporting. The CMS rule promotes interoperability by 25%, cost by 30%, and upgrade by 15%. The limit for the 2022 Performance Year is 75 points, up 15 points from the previous year. Accordingly, the additional performance limit is set at 89 points.
CMS pays $ 30 per injection for certain vaccines administered by CMS. The vaccines are pneumococcal, influenza and hepatitis B viruses. However, CMS rules have been developed to maintain the current $ 40 per dose for COVID-19 vaccine administration.
Until the last day of the current public safety emergency (PHE) schedule year, CMS will adjust the administrative payment rates for the COVID-19 vaccine and other vaccines from the beginning of the year following the end of the relevant year.
Medical Assistants and Medical Services Teaching
As per the CMS rules, the procedures that will be changed for Medical Assistants (PAs) from January 1, 2022, are,
- Medicare can be billed directly for their professional services.
- Other PAs and bills for their PA services can be incorporated with Medicare.
- Can refund payments for their professional services
Suppose a resident participates in a teaching service related to medical teaching. In that case, a teacher doctor can only be billed for their profession if present at a critical part of their service. CMS explains that the time the teacher-physician spends with the resident includes the time it takes to select an outpatient E / M attendance level. Therefore, only MDM can determine the E / M attendance level.
Payments applicable for updates on medical services and medical nutrition treatments
According to CMS’s final rules, one must identify and pay for 85% of the cost of an external payment for physiotherapy. The due dates for physiotherapy assistants and occupational therapy assistants for their services are after January 1, 2022, to get these changes. In addition, CMS has made several policy revisions to therapeutic benefits.
They are primarily crucial for stakeholder support and to promote the proper treatment. According to CMS rules, when physiotherapists and occupational assistants come to care for a patient, they can bill up to 15 minutes of service without a CQ / CO modifier. As per CMS Final Rule 2022.
From January 1, registered nutritionists and nutrition professionals will be required to provide and bill MNT services. To this end, new regulations have been established about CY 2022 to show the relationship between nutrition professionals and NPPs.
In addition, several other policies have been changed in the CMS Final Rule for 2022.We have discussed in this report only a few very salient rules. The Calendar Year (CY) 2022 PFS Final Rule identifies the broadest organizational strategies. CMS aims to create a healthcare system with a perfect approach, quality and innovation in the medical service.