Understanding the Key Impacts of the CY 2022 Medicare Physician Fee Schedule Proposed Rule (MPFS)
Date: 09|02|2021 Approx. 4 min. read
Author: Brianna Plencner, CPC, CPMA Senior Consultant & Manager, Practice Development, HCCI
The first thing to understand about the MPFS proposed rule is that it’s proposed. None of these policy or payment impacts are final until CMS confirms their final decisions in the MPFS final rule, which is typically released in November each year, no later than 12/01.
Right now, we’re in a comment period where CMS is asking for feedback, and we all have an opportunity to make our voices heard with the hope that they will be receptive to feedback and make changes in the final rule. Note: CMS is required by law to read all comments, so it’s worth your time to share your thoughts and opinions. Comment letters can be submitted electronically to CMS until 09/13/21 using the link below:
Proposed Payments for Evaluation & Management (E/M) Services in 2022
Barriers that will impact Home-Based Care if we don’t have change before 2022.
CMS proposes decreasing the conversion factor from $34.89 in CY 2021 to $33.58 in CY 2022. This change reflects the budget neutrality adjustment, the 0.00 percent update adjustment factor, and the expiration of the 3.75 percent increase for services furnished in CY 2021 that protected payments this year as part of the Consolidated Appropriations Act 2021 (CAA).
Two other factors threaten further payment decreases to E/M services, including the resumption of the 2% sequester from the previous year; Congress prevented this last year. Still, we would need additional legislation to delay further. Second, the PAYGO statute as part of the American Rescue Plan would result in a 4% decrease in payments across specialties. Table 123 (pages 1180-1181) in the proposed rule estimates the impact by specialty from the decrease in the conversion factor and RVU changes.
What this means is, as it stands today, we will see payment decreases to the home (CPT 99341-99350) and domiciliary (CPT 99347-99350) E/M services in CY 2022. This threatens the sustainability of many house call programs, and I encourage all of us to urge CMS to continue the 3.75 payment increase to the conversion factor. We need to help them understand that house call clinicians are already at a disadvantage in payment compared to office-based practices. The current fee schedule payment rates for home and domiciliary services do not adequately reimburse for the comprehensive-person-centered care provided under fee-for-service. Review the below comparison of the current 2021 national fee-schedule rates for office-based services compared to the home.
2021 Office-based services payment fee schedule
2021 Home-based services fee schedule
It’s important to understand that all of the flexibilities that currently exist today allowing Home-Based practices to provide and bill for video and audio-only visits are only allowed because of the Public Health Emergency (PHE) declaration and the 1135 telehealth waivers. The PHE must be extended every 90-days and once it’s no longer in effect, access to provide telehealth to patients in their homes will again be restricted. The PHE was last extended on 07/19/21, so we will continue to provide and bill for telehealth services until at least 10/19/21, and it may be extended again, but we will have to continue to monitor.
CMS did create a Category 3 list of telehealth services that will remain on Medicare’s list of telehealth services until the end of CY 2023. However, this does not fix the problem of the home not being recognized as an approved originating site for Medicare telehealth services, nor does this grant flexibilities of the geographic restrictions limiting telehealth outside of the PHE to rural or Healthcare Professional Shortages areas.
If you’re serving a mental health population, there was some good news related to telehealth. CMS proposed to allow the home to be an approved originating site for Medicare telehealth services only for diagnosis, evaluation, and treatment of a mental health or substance abuse disorder. CMS is also proposing to require an in-person visit within the 6-months prior before billing for telehealth services. Audio-only flexibilities will also be available when treating patients with a mental health disorder.
Suppose you want permanent telehealth flexibilities to continue after the PHE. In that case, we need to ask CMS to allow the home as an approved originating site and remove geographic restrictions on populations outside of mental health. Telehealth has proven to be a helpful tool to supplement (not-replace) in-person care. Virtual care helps home-based practices efficiently address acute issues and enhances care coordination and communication with patients/caregivers when they may not be in the patient’s geographic area.
Favorable policies included in the CY 2022 MPFS
CMS changed the definition of “direct supervision” during the PHE to allow the supervising professional to be immediately available through virtual presence using real-time audio/video technology instead of in-person. CMS is proposing to make this flexibility permeant.
Scope of Practice
CMS is proposing to implement section 403 of Division CC of the CAA that authorizes Medicare to make direct payment to Physician Assistants (PAs) for professional services they furnish under Part B beginning January 1, 2022. This allows PAs to be paid directly for their services and offers them the opportunity to reassign their rights to payment for their services in the same way Nurse Practitioners can.
CMS provides additional information and clarity around their definition of when a physician and other qualified health care professionals (e.g., Nurse Practitioner, Physician Assistant) jointly provide a service in the facility setting. If you provide services in a nursing home setting, this applies to you as CMS proposes to allow split/shared services in the SNF setting.
Chronic Care Management (CCM) & Principal Care Management (PCM)
CMS is proposing to increase the wRVU for CCM services and create a new add-on CCM code for services provided entirely by the billing physician or other qualified health care professional (supplements CPT 99491).
PCM services currently exist as HCPCS G2065 and HCPCS G2064. These codes will be replaced by permanent CPT codes. Please note the codes included in the table below with “X” are placeholder codes and not the final new CPT codes that will be confirmed in the final rule.
Snapshots from TABLE 13: CY 2022 Proposed Work RVUs for New, Revised, and Potentially Misvalued Codes (Starting on page 221 of the proposed rule)
Remote Therapeutic Monitoring (RTM): (Page 193 of the proposed rule)
CMS is seeking feedback on potential changes to recognize Remote Therapeutic Monitoring (RTM) codes. These are separate and distinct from Remote Patient Monitoring (RPM) services that exist today. When these codes were created, the intent was for physical therapists and other professionals to be able to bill; however, as the codes are currently constructed, CMS would not allow payment since these professionals cannot bill for E/M services.
As you can see, there is a lot of change ahead. We will be anxiously awaiting the final rule, but until then, all of us Home-Based professionals need to come together and make our voices heard. Don’t miss out on the opportunity to submit comments to CMS by the deadline of September 13th, 2021. Want to connect about any of the issues or policies I laid out in this article? Contact me on HCCI’s HCCIntelligence Hotline at email@example.com.