On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) Final Rule (FR). The rule includes payment and quality provisions that will take effect on January 1, 2022. In addition, CMS produced a fact sheet summarizing the key provisions of the FR.
Below is an overview of what you and your organization need to know to stay compliant:
Medicare Physician Fee Schedule (MPFS) Conversion Factors
With the finalized budget neutrality adjustment to account for changes in RVUs, and the expiration of the 3.75% payment increase provided for Calendar Year (CY) 2021 by the Consolidated Appropriations Act, CMS set the 2022 MPFS conversion factor (CF) at $33.5983, a 3.71% decrease from 2021’s $34.8931.
- Note that the finalized CY 2022 PFS CF of $33.59, is a decrease of $1.30 from the CY 2021 PFS CF of $34.89, and very slight change from the CF in the proposed rule of $33.58.
- The separately calculated Anesthesia CF is finalized at $20.93, a 2.90% decrease from the 2021 CF of $21.56.
CMS estimates an impact to allowed charges from policy changes in the rule as follows. However, that this does not include the overall impact on payments from the expiration of the 2021 3.75% boost to the MPFS CF:
- Anesthesiology: 1%
- Diagnostic Radiology: -1%
- Interventional Radiology: -5%
- Diagnostic Testing Facility: 6%
- Emergency Medicine: 0%
- Critical Care: 0%
- Nuclear Medicine: -1%
- Pathology: 0%
- Radiation Oncology/Therapy Centers: -1%
- Internal Medicine: 0%
- Physician Assistants: 0%
- Nurse Practitioners: 0%
- Independent Laboratory 0%
The 2021 Consolidated Appropriations Act included a 3.75% adjustment to the 2021 CF, which rolled back payment cuts. If Congress does not intervene, the percent decreases mentioned above will be greater for CY 2022. In addition to the 3.75% impact, physicians are also facing additional reductions which require Congressional action:
- -2% sequestration suspended during PHE is expected to be reinstated
- -4% additional sequestration (PAYGO) due to the $1.9 Trillion American Rescue Plan
Shared E/M Visits
The 2022 FR further refines CMS’ longstanding policies concerning shared evaluation and management (E/M) visits. The provisions on this point include the following:
- Definition of shared (or split) E/M visits as those provided in the facility setting by a physician and a non-physician practitioner (NPP) of the same group. The visit is billed by the physician or practitioner who provides the substantive portion of the visit.
- By 2023, the substantive portion of the visit will be defined as more than half of the total time spent. For 2022, the substantive portion can be history, physical exam, medical decision-making, or more than half of the total time (except for critical care, which can only be more than half of the total time).
- Shared visits can be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services.
- A modifier is required on the claim to identify these services to inform policy and help ensure program integrity.
- Documentation in the medical record must identify the two individuals who performed the visit. The individual providing the substantive portion must sign and date the medical record.
These revised policies will be codified in a new regulation at 42 CFR 415.140.
If you have questions, please reach out to your Client Services leader or [email protected].