Boons and Banes of 2022 Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) endorses multiple new rules and policy refinements in the Physician Fee Schedule (PFS) 2022 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 Physician Fee Schedule 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 Physician Fee Schedule 2022 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:  The Proposed Physician Fee Schedule 2022 refines 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:  The Proposed Physician Fee Schedule 2022 refines 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:  The Proposed Physician Fee Schedule 2022 recommends continuing certain services added to Medicare telehealth list during PHE and allows patients to access telehealth services from their homes through audio-only communication technology. 

PA Billing:  The Proposed Physician Fee Schedule 2022 suggests authorizing direct payments to PAs for professional services rendered under Part B, permitting PA to bill Medicare directly.

MDPP:  The Proposed Physician Fee Schedule 2022 also recommends continuing with provider enrolment 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:  The Proposed Physician Fee Schedule 2022 aims to bolsters capabilities through providing mental health services via telecommunication technology, makes technical changes to regulatory text related to COVID-19 vaccines, and solicitates feedback through health equity data collection.

QPP:  The Proposed Physician Fee Schedule 2022 recommends 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 Proposed Physician Fee Schedule 2022 reduces conversion factor by 3.75%, a decrease of $1.31 per RVU for CY2022 when compared with conversion factor for CY2021; this 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 The Proposed Physician Fee Schedule (PFS) 2022 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.