Medicare Fee Schedule Changes In 2023

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Medicare Fee Schedule
Changes In 2023
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Medicare Fee Schedule Changes In 2023

• The internet is ringing with the news of the CMS
  Updates Final rule for the 2023 Medicare
  Physician Fee Schedule. The finalized 2023
  Medicare Physician Fee Schedule was announced by
  the Centers for Medicare Medicaid Services
  (CMS) on November 1 2022. The 2023 MPFS features
  a decrease in the fee schedule conversion factor
  from 34.6062 to 33.0607, reflecting in part the
  expiration of the temporary 3 supplementary
  increase in fee schedule payments for CY 2022,
  among other significant modifications outlined by
  CMS.
• Additionally, the 2023 MPFS includes adjustments
  to telehealth flexibilities that correspond to
  provisions of the 2022 Consolidated
  Appropriations Act, such as the extending of
  several telehealth flexibilities for a period of
  151 days after the COVID-19 Public Health
  Emergency has ended (currently set to expire
  January 11, 2023, but subject to further
  extension). In addition to these revisions, the
  2023 MPFS contains information on revised coding,
  work RVUs, and practice expense RVUs for E/M) and
  other services, as well as revisions to the
  Medicare Shared Savings Program and Quality
  Payment Program.
• Principles of PFS
• On November 1, 2022, the Physician Fee Schedule
  final regulations were published, and they will
  take effect on January 1, 2023.
• Depending on the type of service and the location
  of the treatment, the PFS informs payers
  (insurance companies and patients) of the
  appropriate payment to be made for physicians
  services.

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Medicare Fee Schedule Changes In 2023

• As a result, adjustments to the PFS over time may
  cause a physicians final payment for the same
  service to change.
• The conversion factor is one of the key elements
  of PFS. This is determined by multiplying the
  actual fees paid for a service or treatment by
  the Relative Value Unit (RVU). It seems sense
  that the physicians share of the payment would
  be higher the higher the conversion factor.
• These and other acts that affect physicians and
  other healthcare workers will be closely watched
  by us. If you have any inquiries regarding the
  Final Rule, please get in contact with your DLA
  Piper relationship partner, the authors of this
  notice, or any other member of our healthcare
  sector group.
• Effects of the PFS in 2023 on providers
• Many medical associations have begun to express
  their dissatisfaction with the final guidelines
  for the 2023 Physician Fee Schedule. These
  organizations contend that the reduction in the
  conversion factor will increase financial
  pressure on doctors, put medical professionals
  against one another, and heighten
  competitiveness.
• Additionally, these groups note that this loss
  would come on top of the 4 PAYGO sequestration
  and could result in a further decline in revenue
  in group practices when federal spending exceeds
  a predetermined amount.
• Physicians and other healthcare professionals are
  concerned that this move could cause financial
  instability, and limit their ability to give the
  best care possible to those in need. We must wait
  to see how this will actually impact the
  financial picture.

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Medicare Fee Schedule Changes In 2023

• Patient effects of the 2023 PFS
• The Physician Fee Schedule final rules for 2023
  include a lot of advantages for patients.
• The impact on behavioral health is the main issue
  to be covered. Because the treatments might not
  be reimbursed and the out-of-pocket costs might
  be high, a sizable segment of the population is
  reluctant to seek help from behavioral health
  specialists.
• However, many behavioral difficulties today
  emerge as physical concerns, and unless the
  latter are resolved, the former wont be either.
• The 2023 PFS rules, which contain solutions for
  behavioral health, mental health, and physical
  health, may help provide patients with holistic
  healthcare services.
• When it comes to insurance inclusions, the term
  pain care has always been delicate ground to
  walk on. Access to pain therapy will now be aided
  by higher payment rates for opioid-based
  treatments.
• Patients can look forward to CMS continuing to
  pay for extended telehealth services even after
  the Public HealthEmergency has expired.
• A glance at other factors
• 1. Reduction in the conversion factor and payment
• The conversion factor was reduced by 1.55 in the
  2023 PFS, resulting in a CY 2023 conversion
  factor of 33.06. This conversion factor also
  takes into account the expiration of the
  Protecting Medicare and American Farmers from
  Sequester Cuts Acts temporary, offsetting 3
  increase in payments for CY 2022 as well as the
  statutorily required budget neutrality adjustment
  to take into account changes in payment rates.

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Medicare Fee Schedule Changes In 2023
2. Changes in RUC value for ophthalmic
operations The RUC-recommended practice expense
and work values for the orthoptics CPT code 92065
as well as the RUC-recommended practice expense
and work values for the anterior segment imaging
CPT code 99287 were both accepted by the CMS. 3.
Cataract surgery performed in an office The CMS
said in its proposed rule that it had received
requests to establish non-facility values for the
vitrectomy and cataract surgery codes because it
had been indicated that these procedures may be
carried out in an office setting outside of a
facility in a safe and efficient manner. Before
moving forward with a value, the AOA urged CMS to
assess outcomes information on the effectiveness
of surgeries in this situation. The CMS decided
to further analyze these services before
establishing any values after expressing
reservations about them in the final rule. 4.
Techniques for raising the value of surgical
packages globally The AOA urged a continued
reliance on the RUC process in the CMS proposed
rule when determining how many pre- and
post-surgery visits should be included in a
surgical package. The AOA stated that CMS should
keep using the data gathered from the RUC
Relativity Assessment Workgroups work, which
identifies services with global periods that may
be undervalued. Furthermore, the AOA noted that
such efforts would be better spent evaluating
particular codes of concern as opposed to making
generalizations about the global surgery packages
as a whole.
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Medicare Fee Schedule Changes In 2023
5. Medicare reimbursement for telehealth
services The CMS indicated that while CPT codes
92012 and 92014 would remain on the Medicare
Telehealth Services list through the end of 2023,
CPT codes 92002 and 92004 will be removed after
151 days following the end of the public health
emergency (PHE) declaration. 6. MIPS registry
active participation The CMS and the AOA agreed
that it was necessary to postpone the requirement
that MIPS-eligible clinicians spend one
performance period at the Preproduction and
Validation level of active engagement for each
measure before moving on to the Validated Data
Production level in the following performance
period for which they report a specific measure.
The CMS will postpone this modification until
2024. Conclusion We at Medisys Data Solutions,
the Best medical billing and coding company in
the US, will be closely monitoring these and
other activities that have an effect on doctors
and other healthcare professionals.
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