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Get a glimpse of CMS 2022: Physician Fee Schedule Final Rule

In this article we’ll discuss the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule rule. Visit cms.gov for more information about other 2022 CMS changes.

If you were looking for the 2022 ICD-10 changes, don’t fret! Click here to go to 2022 ICD-10-CM.

Physician Fee Schedule rule

Issued on Nov. 2, this final rule includes the following:

  • updates to payment rates for physicians and other health care professionals for 2022
  • expanded use of telehealth for mental health
  • clarified policies related to split visits, critical care services and teaching physicians
  • and changes to policies for the 2022 performance year of the Quality Payment Program. 

Health care professional payment rate updates

CMS lowered the conversion factor (CF) from $34.89 in calendar year (CY) 2021 to $33.59 for 2022—a decrease of $1.30 (-3.7%). The decrease is partly due to the expiration of the payment increase of 3.75% in CY 2021 due to the Consolidated Appropriations Act of 2021.

Several other across-the-board payment cuts for physicians that could total 9.75% will also go into effect Jan. 1, 2022. CMS also updated clinical labor rates used to calculate practice expenses for CY 2022 over a four-year transition period. 

Expanded use of telehealth for mental health

After adding services to the Medicare telehealth list due to the global health crisis, CMS has determined that certain telehealth services will remain on the list until Dec. 31, 2023. Data will be collected until 2023 to determine whether telehealth list expansion should persist. The Consolidated Appropriations Act of 2021 removed geographic location requirements and allowed patients in-home access to telehealth services for mental health disorders.

 The rule stipulates that qualifying criteria must be met for telehealth services such as prior and subsequent in-person visits with a qualifying physician. Exceptions for subsequent in-person visits may be made based on a patient’s circumstances. 

CMS will still allow payment for behavioral health services offered to patients via audio-only calls.

Clarified policies 

CMS refined policies related to split (or shared) evaluation and management (E/M) visits, critical care services and services provided by teaching physicians involving residents. 

Split or shared E/M visits are defined as the following:

Visits provided in a facility setting by both a physician and a non-physician provider in the same group. The provider who administers the substantive portion of the visit would bill for the visit. 

In 2022, the “substantive portion” is determined based on criteria such as medical history, physical exam, medical decision-making or more than half of total time spent. However, in 2023, the “substantive portion” will be solely defined by more than half of the total time spent. 

Note: Critical care services may be paid on the same day as other E/M visits by the same provider or another provider in the same group and specialty if care is provided prior to critical services (when critical care was not required). Plus, critical care services will NOT be bundled in a global surgical period if unrelated to the surgical procedure. 

This rule dictates that only the time the teaching physician was present can be included when determining E/M visit level between teaching physician and resident. That is, unless considered primary care, where only medical decision-making would be used in determining visit level.

Quality Payment Program policy changes

CMS finalized changes to reporting and participation options for providers in the Quality Payment Program.

The MIPS Value Pathways (MVPs) go into effect in 2023, setting up scoring policies for MVPs and subgroups. 

In the 2026 performance year, multispecialty groups must form subgroups in order to report MVPs. Subgroup reporting will be voluntary for the 2023, 2024 and 2025 performance years. 

Other notable changes to MIPS include the following (for the 2022 performance year):

  • Performance category weights now include 30% for quality, 30% for cost, 15% for improvement activities and 25% for promoting interoperability.
  • CMS revised reporting requirements for promoting interoperability.
  • CMS added five episode cost measures to the cost category.
  • Performance now has a threshold of 75 points, 15 points more than 2021. 

CMS also released a Physician Fee Schedule fact sheet and Quality Payment Program resources along with the rule. You can also read the full physician fee schedule rule here

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