CMS pitches physician payment rule for 2023: 7 things to know

CMS released its annual proposed changes to the physician fee schedule for 2023 on July 7, which includes a proposed $1.53 conversion factor decrease. 

Seven things to know:

1. The proposed physician fee schedule conversion factor for 2023 is $33.08, down from $34.61 in 2022. The proposal considers a statutory requirement that the conversion factor for 2023 remain flat as well, due to the expiration of the 3 percent increase in physician fee schedule reimbursement payments in 2022 that was required in the Protecting Medicare and American Farmers From Sequester Cuts Act.

2. To help address the shortage of behavioral health practitioners, CMS is proposing to allow licensed professional counselors, marriage and family therapists, and other types of behavioral health practitioners to provide behavioral health services under general (rather than direct) supervision. CMS is proposing to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient's primary care team.

3. CMS is proposing to bundle certain chronic pain management and treatment services into new monthly payments to improve patient access to team-based comprehensive chronic pain treatment. CMS is also proposing to cover opioid treatment and recovery services from mobile units to increase access for people who are homeless or live in rural areas.

4. CMS is proposing to incorporate advance shared savings payments to certain new Medicare shared savings program ACOs. This would be one of the first times traditional Medicare payments would be permitted for such uses, and CMS said it is expected to be an opportunity for providers in rural and other underserved areas to make investments needed to become an ACO. CMS is proposing that smaller ACOs have more time to transition to downside risk.

5. CMS is proposing a health equity adjustment to an ACO's quality performance category score to reward excellent care delivered to underserved populations. It is also proposing benchmark adjustments to encourage more ACOs to participate and succeed. The goal is to have all traditional Medicare recipients in an accountable care relationship with a healthcare provider by 2030. 

6. CMS is proposing to pay for dental services, such as dental examination and treatment, preceding an organ transplant. CMS is seeking comment on other medical conditions where Medicare should pay for dental services, such as for cancer treatment or joint replacement surgeries.

7. The 60-day comment period closes on Sept. 6.

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