Doctor caring for patient at home

Date: 01/06/2022   Approx. 2 min. read
Author: Brianna Plencner, CPC, CPMA  Senior Consultant & Manager, Practice Development, HCCI

Here we are in the new year. Many practices and providers want to know how to prepare for success as we all continue to navigate this challenging healthcare environment. If you joined us for December’s HCCIntelligence Webinar, you heard Dr. Paul Chiang and I cover significant coding and reimbursement information with the attendees during the hour, but of course, nothing regulatory is ever simple.

Here is a summary of the top payment & policy key impacts as we begin 2022.

Medicare Physician Fee Schedule Payments in CY 2022:

Congress acted to pass legislation that delayed the more substantial payment decreases healthcare providers were facing. However, the 2% sequester decrease to the Medicare Physician Fee Schedule (MPFS) is required by law. However, it will be implemented in a phased approach.

As of 01/01/22, there was a 0.75% decrease to MPFS payment rates across the board, then an additional 1% decrease will occur April- June 2022, followed by another 1% decrease July-December 2022. So, when it is all said and done, the total payment impact will be -2.75% for this year.

Remember to optimize your billing models to be appropriately paid for the comprehensive services you provide to a complex population. There are many options to boost revenue outside of Evaluation & Management (E/M) visits, such as Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Cognitive Assessment & Care Planning visits.

Telehealth After the Public Health Emergency (PHE) Ends:

The current PHE remains in effect until 01/16/22 (with a high likelihood of being extended again, although I don’t have a crystal ball), continuing all the waivers and flexibilities we have in place to provide and be paid for telehealth services for patients located at home.

Whenever the PHE is officially declared over, CMS does not have the statutory authority without legislative action to continue covering telehealth services for patients located at home unless it’s for the purposes of diagnosis, evaluation, or treatment of a mental health disorder. After the PHE the requirements for telehealth services for patient’s located at home for the treatment of a mental health or substance abuse condition include:

  • An in-person non-telehealth service must have been provided by the billing provider within the 12 months prior to billing for telehealth
  • Subsequent non-telehealth (i.e., in-person) visits must be provided by the billing provider or provider within the same group at least once every 12-months for the patient receiving Medicare telehealth services from home (Limited exceptions apply when documented within the medical record)
  • Modifier will be required on the claim

This will be Medicare’s fee-for-service policy after the PHE, and there is coverage for audio-only services (new HCPCS modifier FQ- service was furnished using audio-only technology) in certain scenarios as well. If your practice participates in an Alternative Payment Model (APM) or other value-based contracts, you may be able to take advantage of telehealth waivers that grant flexibility regardless.

For more information, a recording and presentation handouts for our December HCCIntelligence Webinar are available within the HCCI Learning Hub, which covered the changes in greater detail.

HCCI would like to wish everyone a safe and healthy New Year! A sincere thank you to all healthcare professionals for all you do and continue to do to support the patients, caregivers, and communities you serve.