On July 13, 2021, CMS issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), along with other Medicare Part B issues. CMS is accepting comments on the proposed rule until September 13, 2021. A summary of key details within the proposed rule follows below.

Calendar Year (CY) 2022 MPFS Ratesetting and Conversion Factor

For CY 2022, CMS is proposing a reduction of the conversion factor from $34.89 to $33.58, due to the proposed budget neutrality adjustment, accounting for changes in relative value units (RVUs) as well as the expiration of the 3.75 percent COVID-19 payment increase provided by the Consolidated Appropriations Act for CY 2021. The changes in RVUs stem from the implementation of revised E/M policies, which Advis summarized here. These changes include rate increases for E/M visit codes; the changes will likely benefit general and family practitioners while causing a reallocation of Medicare payments that may prove detrimental to specialists. The policy may also result in increased provider compensation costs for certain entities, such as health systems and hospitals, that utilize wRVU-based provider services agreements.

Telehealth Services under the MPFS

CMS intends to allow certain services added to the Medicare telehealth list during the COVID-19 Public Health Emergency (PHE) to remain on the list until the end of December 31, 2023, to evaluate whether the services should be permanently added to the telehealth list following the end of the COVID-19 PHE.

CMS is also proposing to eliminate geographic restrictions on mental and behavioral health telemedicine visits and to make the patient’s home an originating site, so long as the patient and provider meet in-person within six months of beginning telehealth services and participate in at least one in-person visit every six months thereafter.

The new rule would also pay providers for giving certain mental and behavioral healthcare services to patients via audio-only telehealth calls. However, payment would only be met for certain services, including counseling and therapy for opioid treatment.

Physician Assistant (PA) Services

CMS is proposing that, beginning January 1, 2022, PAs would be able to bill Medicare directly for their services and reassign payment for their services. Currently Medicare can only make payment to the employer or independent contractor of a PA. Consequently, PAs cannot bill and be paid for their professional services by the Medicare program directly; they also do not currently have the option to reassign payment for their services or to incorporate with other PAs to bill the program for PA services. With this proposal, CMS is recognizing the trend toward treating PAs/APPs as autonomous providers.

Medicare Provider Enrollment

CMS is proposing several provider enrollment regulatory revisions. These include:

  • Expanding authority to deny or revoke a provider’s or supplier’s Medicare enrollment.
  • Establishing specific regulatory rebuttal procedures for providers and suppliers whose Medicare billing privileges have been deactivated.
  • Exempting certain types of independent diagnostic testing facilities (IDTF) from several of the IDTF standards: A selection of IDTFs perform diagnostic services via off-site computer modeling and analytics performed by a technician or other forms of testing not involving direct beneficiary interaction. These entities can still qualify as IDTFs so long as they meet the applicable requirements of § 410.33, but cannot (and thus cannot enroll in Medicare) strictly because of the test’s indirect nature. CMS is proposing that IDTFs that have no beneficiary interaction, treatment, or testing at their practice location would be either partially or wholly exempt from certain requirements in § 410.33.

Appropriate Use Criteria (AUC) Program

CMS is proposing to begin the payment penalty phase of the AUC program on January 1, 2023, or the January 1 that follows the declared end of the PHE for COVID-19, whichever is the later date.

Medicare Shared Savings Program 

CMS is giving Accountable Care Organizations (ACOs) more time to convert to reporting electronically.

Physician Self-Referral

CMS is going to consider an unbroken chain of financial relationships between a physician and an entity that meets the other conditions of § 411.354(c)(2)(i) through (iii), to be an indirect compensation arrangement if the unit of compensation received by the physician (or immediate family member) is payment for anything other than services personally performed by the physician (or immediate family member).

For any questions regarding the Medicare Physician Fee Schedule Proposed Rule, the potential impact on providers, or any other health care regulatory and/or operational matters, please call 708.478.7030 or simply contact Advis.

Published: July 15, 2021