Medicare
Jul 22, 2021
Helping practices thrive, not just survive.
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The Centers for Medicare & Medicaid Services (CMS)released the final 2023 Medicare Physician Fee Schedule (PFS) rule thisafternoon, which in addition to major payment implications, includes changes tothe 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 physicianservices. For 2023, CMS finalized a conversion factor of $33.0607 and $20.6097for Anesthesia (a decrease of -4.47% and -4.42%, respectively, over final 2022rates);
• Finalizes implementation of provisions of theConsolidated Appropriations Act, 2022 that extend the application of certainMedicare telehealth flexibilities for an additional 151 days after the end ofthe COVID-19 public health emergency (PHE), such as allowing telehealthservices to be furnished to patients in their homes;
• Extends flexibilities to permit split/shared E/Mvisits to be billed based on one of three components (history, exam, or medicaldecision making) or time until 2024;
• Expands access to behavioral health bypermitting marriage and family therapists, licensed professional counselors, andothers to furnish behavioral health services under general supervision insteadof direct;
• Maintains the MIPS performance threshold at 75points for the 2023 MIPS performance year/2025 payment year;
• Adds five new MIPS Value Pathways related tonephrology, oncology, neurological conditions, and promoting wellness, forvoluntary reporting beginning in 2023; and
• Creates an advanced incentive payment pathwayfor certain low-revenue, new entrant accountable care organizations to bolsterparticipation in the Medicare Shared Savings Program.
Initially, physician’s offices had a person in-house that handled everything having to do with billing for the practice. This person added to the overhead of the office – about 10 – 12% and handled everything from A-Z in the billing process. General knowledge of codes was all that was needed to ensure reimbursement from insurance companies as this was before managed care.
The beginning of managed care brought to the industry fee schedules, preferred provider contracts, the need for pre-authorizations and more. These changes meant a more intensive knowledge of medical codes was required as well as continuing to keep updated as codes were added and deleted. These changes increased cost and time required to handle billing.
Initially, physician’s offices had a person in-house that handled everything having to do with billing for the practice. This person added to the overhead of the office – about 10 – 12% and handled everything from A-Z in the billing process. General knowledge of codes was all that was needed to ensure reimbursement from insurance companies as this was before managed care.
The beginning of managed care brought to the industry fee schedules, preferred provider contracts, the need for pre-authorizations and more. These changes meant a more intensive knowledge of medical codes was required as well as continuing to keep updated as codes were added and deleted. These changes increased cost and time required to handle billing.
Our Complimentary Consultation is a discovery and feedback initiative built to help practices. You get one on one advice from our experts, plus a report for your practice to use, absolutely free for you.
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After listening to what clients were asking for, a more robust system was created that covered more than just standard medical billing. This full-cycle revenue management system saved doctors time and money by eliminating the need to have different people handling all other aspects. Revenue Cycle Management includes: