Late last week, CMS released its annual proposed changes to the Physician Fee Schedule for 2022. The draft covers many important changes that will impact payment rules for the new year. Public comment will be taken until September 13th, and providers are encouraged to submit feedback, as this will be considered to develop final PFS policy. Submit a public comment here. Read the full text of the proposed rule here.
Proposed rule highlights:
Conversion Factor Decrease
With pandemic relief ending, the 3.75 percent payment increase will expire at the end of 2021. CMS is required by law to calculate a budget neutrality adjustment to account for changes in relative value units. As such, the proposed Physician Fee Schedule conversion factor for 2022 is $33.58, reduced from $34.89 in 2021. The AMA prepared an analysis to show the impact on specialties, you can view the document here.
Telehealth Provisions
CMS proposed allowing category three (temporary) codes, currently on the Medicare telehealth list, to remain active until Dec. 31, 2023. CMS commented they needed more time to determine if services should be permanently added to the list. Medicare will continue to allow patients to access telehealth services within their home through this time period. CMS is soliciting public comment to further evaluate if audio-only communication for certain mental health disorders should continue to be paid after the PHE.
Remote Therapeutic Monitoring (RTM)
CMS proposed the creation of five new codes (CPT codes 989X1, 989X2, 989X3, 989X4, and 989X5) defining Remote Therapeutic Monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response), with a similar billing structure to the Remote Patient Monitoring (RPM) code series. The RTM family includes three practice expense codes, and two codes that include professional work. Billers of RTM codes are projected to be nurses and physical therapists yet, if policy requires the series as “incident to” the providers services, this would not allow therapists to bill these services independently.
Pain Management
CMS recognizes that current series of CPT codes (new and established E/M or Chronic Care Management (CCM)) might not capture the complexity of managing patients on chronic pain medications. As part of this, they recognize the importance of telecommunication technology as a resource for patient access. CMS is soliciting public comment on developing a specific CPT code or ‘add-on’ code to account for this complex work and care coordination.
Physician Assistant Billing
Starting January 1, 2023, Physician Assistants (PA) would be able to bill Medicare directly and reassign payment for their services, no different than Nurse Practitioners. Under the current rules, PA’s can only be paid under their employer or independent contractor.
Shared Services (Split/Shared) & Critical Care Services
On May 26th, 2021 CMS removed sections of the Internet Only Manual (IOM) regarding shared services and critical care. The removal of this information is in response to a petition received in January by the U.S. Department of Health and Human Services (HHS), pursuant to the HHS Good Guidance Practices Regulation. The proposed rule outlines numerous changes to these sections. Highlights as follows:
Shared Services
· Starting January 1, 2022, shared services (split/shared) will only apply to facility services. CMS proposed a new definition of a shared visit as an E/M visit in the facility setting that is performed in part by both a physician and an APP who are in the same group practice, in accordance with applicable laws and regulations. The facility setting is defined as an institutional setting in which payment for services and supplies furnished “incident to” a physician or practitioner’s professional services is prohibited.
· CMS’s policy would be modified to allow physicians and Advanced Practice Provider’s (APP) to bill for shared visits for both new and established patients, and for critical care, and certain skilled Nursing Facility /Nursing Facility (SNF/NF) E/M visits.
· Only the physician or APP who performs the substantive portion of the shared visit would bill for the visit.
· CMS is proposing to define “substantive portion” as more than half of the total time spent by the physician and non-physician practitioner performing the visit. The 2021 E/M guidelines will not apply to facility services for 2022 (meaning the 1995/97 will continue to govern facility E/M visits).
· Time will be revised to clarify ‘distinct time’ where MD/APP time could be summed together. If the MD/APP jointly see the patient, this time would be considered one single time. Time will need to be documented, by both the MD and APP to track the billing for the shared service.
· CMS plans to define appropriate activities that are non-face-to-face in the facility setting but also plans to create a separate list for critical care. They are soliciting comments on this specifically.
· The draft rules propose the creation of a modifier to describe shared visits. This would need to be appended to claims for shared visits, whether the physician or APP bills for the visit.
Critical Care
· CMS plans to revise the IOM manual to adopt the definition of critical care from the CPT manual for consistency and clarity.
· As part of the manual revision and to improve transparency of the policy, language will include that the physician or APP would report the base CPT code 99291 for the first 30-74 minutes of critical care services provided to a patient on a given date. Providers of the same group practice would report an add-on CPT code 99292 for each additional 30-minute time increments provided to the same patient.
· A major change would include that no other E/M visit can be billed for the same patient on the same date as a critical care service when the services are furnished by the same practitioner, or by practitioners in the same specialty in the same group. In the past, a provider could bill an initial or subsequent visit, in addition to a critical care visit, if the patient started to deteriorate. CMS felt this created ‘duplicate’ billing and did not conform with other policy language.
· The evaluation of global packaging of surgical services is ongoing and will continue to have a 10- or 90-day value. Because critical care visits are included in some 10- and 90-day global packages, CMS is proposing to bundle critical care visits with procedure codes that have a global surgical period. This could have a huge impact on specialties that only provide critical care services to post-operative patients.
The proposed rules also cover new FQHC payments, quality payment program changes, Medicare share savings and diabetes prevention program changes. If you are concerned about any of these proposed rules, we recommend submitting comments to endorse or dispute prior to the September 13th deadline.
If you are needing more information on the PFS proposed rule or provider education for your medical group, please contact Jana Weis at jana.gill@gillcompliance.com for a free consultation.