CMS pitches physician payment rule for 2022: 9 things to know

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CMS released its annual proposed changes to the Physician Fee Schedule for 2022, which expands certain Medicare telehealth provisions and updates the payment rate for physician services.

Nine things to know about the proposed rule:

1. Payment rate update. With the budget neutrality adjustment to account for changes in relative value units, as required by law, and expiration of the 3.75 percent payment increase provided in 2021 by the Consolidated Appropriations Act, the proposed Physician Fee Schedule conversion factor for 2022 is $33.58, down from $34.89 in 2021.

2. Telehealth provision expansion. CMS proposed allowing certain services added to the Medicare telehealth list amid the pandemic to remain until Dec. 31, 2023, to give the agency more time to determine if the services should be permanently added following the public health emergency. CMS also said it will allow all Medicare patients to access telehealth services from their homes and is proposing to allow audio-only communication technology when used for the diagnosis, evaluation or treatment of mental health disorders. 

3. Appropriate Use Criteria penalty phase delay. CMS is proposing to delay the implementation of a penalty phase of the Appropriate Use Criteria program. Currently the penalty phase is set to begin Jan. 1, but CMS proposed delaying it to Jan. 1, 2023, or the Jan. 1 that follows the end of the public health emergency. 

4. Quality Payment Program changes. CMS proposed to increase the Merit-based Incentive Payment System performance threshold score providers must exceed to receive bonuses under the Quality Payment Program. CMS also unveiled the first seven optional MIPS value pathways that would begin in 2023. The seven payment pathways would be emergency medicine, chronic disease management, heart disease, anesthesia, lower-extremity joint repairs, rheumatology and stroke care.

5. Physician assistant billing. Beginning Jan. 1, physician assistants would be able to bill Medicare directly for their services and reassign payment for their services. Currently, Medicare can only make a payment to the employer or independent contractor of a PA.  

6. Medicare Shared Savings program updates. CMS is proposing to give ACOs more time to transition to electronic reporting. In particular, CMS would allow ACOs to continue to use the web interface reporting option in 2022 and 2023 and phase in the new electronic clinical quality measure reporting requirement over three years. It was initially set to start in 2022.  

7. Medicare Diabetes Prevention Program changes. CMS plans to waive the provider enrollment application fee for all organizations when they seek to enroll in Medicare as a Medicare Diabetes Prevention Program supplier on or after Jan. 1. CMS also proposed to shorten the prevention program services period to one year by removing the ongoing maintenance sessions phase. CMS also proposed redistributing a portion of the ongoing maintenance sessions phase payments to other core performance categories. 

8. Comment solicitation. CMS is seeking provider input on two issues related to COVID-19. First, CMS wants input on what qualifies as the "home" in its preliminary policy to pay $35 add-on for certain beneficiaries when they receive a COVID-19 vaccine at home. Second, CMS is seeking comments on whether COVID-19 monoclonal antibody products should be treated the same way as other physician-administered drugs and biologics under Medicare Part B. 

9. Comment period. Comments on the proposed rule are due Sept. 13.

Access the full rule here

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