On July 7th of this year, the Centers for Medicare & Medicaid Services (CMS) proposed a new rule that solicits public comments on proposed policy changes for medicare payments. This proposed change would fall under the Physician Fee Schedule (PFS) as well as other Medicare Part B issues. Should this ruling be passed, it will become effective on or after January 1st, 2023.
This proposed rule is just one of several that are made to reflect a much broader administration-wide plan to create a more fair-minded health care system in hopes of resulting in better accessibility, affordability, quality, and innovation. In this post, we’ll take a look at this newly suggested ruling and how it would affect next year’s Physician Fee Schedule.
Physician Fee Schedule Rate Setting and Conversion Factor
Two influential areas of PFS that are bound to be altered from this new ruling are rate setting and conversion factor. This new rule proposes a collection of standardized technical proposals that involves practice expense. This will include the application for the second year of clinical labor pricing update. Along with this implementation, a comment solicitation has also been included to develop a consistent approach to utilizing new data in setting PFS rates.
Conversion factors are also predicted to be affected by this proposed rule. The proposed CY 2023 PFS conversion factor is at $33.08, resulting in a slight decrease of $1.53 from the CY 2022 PFS conversion factor of $34.61. This number comes from the required statutory update to the conversion factor of CY 2023 of 0%, as well as the expiration of the 3% increase in PFS payments in 2022.
These possible changes are being considered in hopes of achieving transparency and predictability in payment amounts as well as obtaining stable conversion factors across the board.
Physician Fee Schedule Changes In Telehealth
The functionality of Telehealth will be impacted by these proposed changes with a number of policies that would include making a number of services that are only temporarily available through CY 2023 readily accessible. This, in turn, would grant more time for the collection and interpretation of critical data that could make an impact on eventual inclusions to the Medicare Telehealth services list. In addition, the potential changes will also extend the duration of time that services are on the Telehealth services list.
These policies are under consideration in hopes of extending specific flexibilities during PHE and 151 days past it, resulting in Telehealth services being available in any geographic area or site setting. This can include the beneficiary’s home, which can warrant certain services to be fulfilled through strictly audio telecommunications. With these possible alterations, care providers such as physical therapists, occupational therapists, speech-language pathologists, audiologists, and PALTC practice groups can utilize any Telehealth services.
Behavioral Health Services
One side of the industry that is being directly affected by the prospective changes is behavioral health. And with these changes, long-term care facilities such as nursing homes are more accessible to the proper PALTC practice support. During the 2022 CMS Behavioral Health Strategy, a goal was set to improve access to quality mental health services. With revisions in consideration to reduce existing barriers, this new proposal would make greater use of behavioral health services like professional counselors and even licensed marriage and family therapists.
These new suggestions are being considered in order to broaden the range of services being offered in behavioral health facilities. This will not only streamline basic processes but will make greater use of basic services. With these impending changes, behavioral health facilities will be able to provide services for a higher number of individuals.
For further information on behavioral health and PALTC practice support, check out our blog post here.
PFS Update Wrapped-Up
With these changes possibly on the horizon, it’s important to stay up to date with any alterations or amendments that may follow. Working with behavioral health facilities and Telehealth services, Saisystems is here to keep you informed and updated on any changes in PFS.
Make sure to fill out the form below to download a free FAQ form about the Medicare fee schedule.