The Medicare Final Rule: Talking Points and News Updates

New rule could severely impact the wallets of physicians.

Medicare published multiple final rules for 2022 on Nov. 2, with their provisions having been added to, updated, and revised since then. Not only that, the federal government also has its hand in attempting to halt or suspend certain cuts to the Medicare program, which could find physicians seeing the biggest pay cut in Medicare reimbursements in years.

Here are the current highlights of the final rules, as of this date:

• Provider Relief Funding (PRF): the first reporting date for Phase 1 deposits into Medicare provider accounts closed on Nov. 30. Physicians, hospitals, and providers that received that initial PRF deposit were required to report how the money was used, in relationship to the COVID-19 pandemic losses and expenses, or otherwise return all of the funding. Please see HRSA.gov for more information;
• The No Surprises Act bars surprise balancing billing patients from facilities and certain providers, for emergent and non-emergency services, without consent, if the providers are out of network. This becomes effective Jan. 1, 2022. This new rule has a lot of moving parts, and healthcare professionals will need to do their due diligence to make sure they are in compliance with the new rule or face consequences;
• Medicare beneficiaries’ premium was increased 14 percent;
• Medicare Part B deductible for 2022 was increased to $233, up from $203 in 2021;
• Medicare Part A deductible for 2022 was increased to $1,556, up from $1,484 in 2021;
• The one-year fix on the Medicare Physician Fee Schedule (MPFS) is decreasing from $34.89 to $33.59 in 2022 (this allows for the 3.75-percent one-year fix to be removed from the CF, as directed in the 2020 final rule). However, there is a bill to raise the federal debt ceiling that has to pass the Senate, now that it has passed in the House, to add back in 3 percent to the CF for 2022 and suspend some other funding cuts that would equal the Medicare cuts to 9.75 percent;
• There were two HCPCS modifiers introduced for split/shared visits and critical care services on the same date as an unrelated evaluation and management (E&M) service. See -FS and -FT in your HCPCS 2022 manual for definitions and how to report those services in 2022;
• Telehealth CAT 3 codes (PRM) and device care will continue temporarily through 2023, until the Centers for Medicare & Medicaid Services (CMS) can get a better handle on efficacy under the telemedicine coverage;
• Telehealth audio-only services will continue for mental and behavioral health services permanently for certain conditions, but will have U.S. Department of Health and Human Services (HHS) oversight for overutilization; and
• Telehealth audio-only CPT codes will be discontinued for coverage in 2022, but the G2252 11-20-minute audio-only HCPCS code will be a permanent option for patients unable to get to an in-person visit, or patients with lack of broadband for an audio and video visit, or when a physician may not be able to see the patient in person.

Programming Note: Find out even more details on the 2022 final rules and tune in for a Medicare Physician Fee Schedule update on during today’s TalkTen Tuesdays, 10 Eastern.