Medicare Finalizes 2023 Payment and Quality Reporting Changes

Originally published in the November 1, 2022, issue of MGMA’s MGMA Regulatory Alert
Reprinted with permission from MGMA

The Centers for Medicare & Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (PFS) rule this afternoon, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2023. The final rule:

• Sets 2023 Medicare payment rates for physician services. For 2023, CMS finalized a conversion factor of $33.0607 and $20.6097 for Anesthesia (a decrease of -4.47% and -4.42%, respectively, over final 2022 rates);
• Finalizes implementation of provisions of the Consolidated Appropriations Act, 2022 that extend the application of certain Medicare telehealth flexibilities for an additional 151 days after the end of the COVID-19 public health emergency (PHE), such as allowing telehealth services to be furnished to patients in their homes;
• Extends flexibilities to permit split/shared E/M visits to be billed based on one of three components (history, exam, or medical decision making) or time until 2024;
• Expands access to behavioral health by permitting marriage and family therapists, licensed professional counselors, and others to furnish behavioral health services under general supervision instead of direct;
• Maintains the MIPS performance threshold at 75 points for the 2023 MIPS performance year/2025 payment year;
• Adds five new MIPS Value Pathways related to nephrology, oncology, neurological conditions, and promoting wellness, for voluntary reporting beginning in 2023; and
• Creates an advanced incentive payment pathway for certain low-revenue, new entrant accountable care organizations to bolster participation in the Medicare Shared Savings Program.

MGMA submitted detailed comments in response to the proposed rule in September. Be on the lookout for a more detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP) in the coming weeks.

Additional information about the final rule is available in the PFS fact sheet and the QPP fact sheet.

Your Guide to 2020 Payment Rules & MIPS Requirements

Originally published in the November 20, 2019 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

It’s here! Your Guide to 2020 Payment Rules
& MIPS Requirements

DOWNLOAD MGMA’S MEMBER EXCLUSIVE ANALYSIS

The Centers for Medicare & Medicaid Services (CMS) released the final 2020 Physician Fee Schedule (PFS), which includes payment updates for Medicare services, changes to billing guidance for certain codes, and modifications to reporting requirements under the Merit-based Incentive Payment System (MIPS).

MGMA Government Affairs reviewed, analyzed, and distilled this nearly 2,500-page final rule in a member-benefit analysis. The resource breaks down significant payment and quality reporting changes for 2020 and offers practical takeaways for busy medical group practice executives. Key regulatory provisions include:

• The CY 2020 PFS conversion factor remains relatively flat at $36.0896. The CY 2020 national average anesthesia conversion factor will be $22.2016.
• In 2021, CMS will maintain separate payment rates for E/M office visits, delete level 1 office visits for new patients, and increase the payment rate for E/M services.
• Payment rates for transitional care management services will increase in CY 2020.
• The MIPS score to avoid a negative payment adjustment in 2022 will increase to 45 points based on performance in 2020.

MGMA will provide further education on this complex regulation during our 2020 Medicare Payment Outlook member-benefit webinar on Thursday, Dec. 5 at 1 pm ET. Register now to join us and learn more about how your organization can prepare for these new policies in 2020.

Regulatory Alert: CMS Finalizes 2020 Payment and Quality Reporting Changes

Originally published in the November 1, 2019 issue of MGMA’s Washington Connection
Reprinted with permission by MGMA

Today, the Centers for Medicare & Medicaid Services (CMS) released the final 2020 Physician Fee Schedule (PFS), which includes payment updates and modifications to the Merit-based Incentive Payment System (MIPS) reporting requirements and alternative payment model (APM) participation options starting Jan. 1, 2020. The final rule:

• Sets the CY 2020 PFS conversion factor at $36.0896. The CY 2020 national average anesthesia conversion factor will be $22.2016.
• Deletes level 1 office visits for new patients and maintains separate payment rates for E/M office visits starting in 2021.
• Outlines changes to MIPS reporting requirements, including increasing the performance threshold to avoid a payment penalty in CY 2022 based on CY 2020 performance.
• Increases the MIPS payment adjustment to +/- 9%.
• Maintains the (up to) 10% exceptional performance bonus and current MIPS performance category weights from the 2019 performance period.

For more information, review the physician payment fact sheet and QPP fact sheet associated with the 2020 final PFS. MGMA will analyze the final rule and provide a detailed analysis as a member benefit. Contact MGMA government affairs with questions by emailing govaff@mgma.org or calling 202.293.3450, 877.275.6462 toll-free.