Boons and Banes of 2022 Physician Fee Schedule

Reduced Conversion FactorTelehealth FlexibilitiesQuality Incentives, and More

The Centers for Medicare & Medicaid Services (CMS) endorses multiple new rules and policy refinements in 2022 Medicare Physician Fee Schedule (PFS) Proposed Rules focusing primarily on expanding access to services via telehealth, advancing quality payment programs, enhancing diabetes prevention programs, authorizing physician assistant billing, etc.  Keeping Medicare payments budget neutral, the PFS applies a $33.58 conversion factor for 2022 down from $34.89 in 2021, a reduction of 3.75% in conversion factor used to calculate payments to physicians.  A technology-driven solution such as RevCDI-led coding from Reventics not only helps recoup any payment cuts, but also maximizes reimbursements and quality incentives by empowering physicians to capture relevant data to establish integrity of services furnished for coding compliance and accurate charge capture. 

The 2022 PFS impacts practitioners across different practices and health programs including, but not limited to: 

  • Evaluation and Management Services (E&M); 
  • Critical Care Services; 
  • Physician Assistant (PA) Services; 
  • Teaching Physician Services; 
  • Telehealth Services; 
  • Vaccine Administration Services; 
  • Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs); 
  • Quality Payment Program (QPP); 
  • Medicare Diabetes Prevention Program (MDPP), etc. 

New Rules and Policy Updates 

E&M Services:  Refining of an E&M visit code set for split or shared E&M visits provided by a physician and non-physician practitioner (NPP) in the same group, allowing services to be billed by the provider who spends more than half of the total time. 

Critical Care Services:  Refinements to current policies for critical care services including using AMA’s CPT prefatory language as definition of critical care visits and furnishing critical care services as split or shared visits. 

Telehealth Services:  Continuing with certain services added to Medicare telehealth list during PHE and allowing patients to access telehealth services from their homes through audio-only communication technology. 

PA Billing:  Proposal to authorize direct payments to PAs for professional services rendered under Part B, permitting PA to bill Medicare directly. 

MDPP:  Continuing with provider enrollment fee waiver for new organizations enrolling as MDPP Supplier, shortening prevention program services, removing ongoing maintenance session phases, and redistributing a portion of their payments to other core performance categories. 

RHCs and FQHCs:  Bolstering capabilities through providing mental health services via telecommunication technology, technical changes to regulatory text related to COVID-19 vaccines, and soliciting feedback through health equity data collection

QPP:  Increasing MIPS performance threshold score for providers to exceed and receive bonuses.  CMS declares first seven optional MIPS value pathways to begin in 2023 and the performance category weights

Comment Solicitation:  CMS seeks public/stakeholder input on preliminary policy to pay $35 add-on for COVID-19 vaccination done at home, while also seeking inputs on COVID-19 monoclonal antibody products and other common non-COVID-19 vaccines.  Also, solicits comments on multiple services and programs to include telehealth services, shared savings program, digital quality measurement, etc. 

What Pays Less: 

The reduction in conversion factor by 3.75%, a decrease of $1.31 per RVU for CY2022 when compared with conversion factor for CY2021, can reduce reimbursements to certain practices including, but not limited to: 

  • Emergency Medicine and other Hospital-based practices
  • Surgical care practices, vascular surgeries, ophthalmology practices, etc, due to inflation. 
  • Rehabilitation services through cuts for services provided by physical and occupational therapy assistants. 
  • Diagnostic services including portable x-ray through sequestration. 
  • Cardiology practices can see a decrease in reimbursement by about 2% from 2021 to 2022 (according to estimates).

What Pays More: 

  • E&M services through direct payments to physician assistants and teaching physicians
  • Telehealth services through extension of PHE telehealth flexibilities and payments for mental and behavioral services rendered at patient’s home. 
  • QPP through providing financial incentives to physicians meeting MIPS Value Pathways. 
  • MDPP through higher payments to suppliers for participants reaching milestones and enrollment fee waivers

How Reventics Helps 

New rules, policy refinements, and quality incentives in 2022 PFS necessitate comprehensive documentation of all services furnished to maximize compliant revenue.  Reventics uses a clinically-focused and analytics-led approach to deliver provider engagement solutions improving physician reimbursement and compliance while elevating clinical quality measures performance.