ED Coding and Reimbursement Alert

If you’re hoping for a CF increase, prepare to be disappointed.

Even though the COVID-19 public health emergency (PHE) is in the past, its impact is very much in the present proposed updates for calendar year (CY) 2024. Read on for the details.

Background: The Centers for Medicare & Medicaid Services (CMS) recently released the CY 2024 Medicare Physician Fee Schedule (MPFS). The agency addresses several post-PHE hot topics, offering policy fixes for next year.

There wasn’t enough time to digest the entire document, but we will provide an in-depth analysis in the January. In the meantime, check out a couple of highlights from the final rule and four elements of the proposed rule that will be addressed in next month’s issue of ED Coding & Reimbursement Alert.

News Flash: CMS Releases MPFS for 2024

The CMS 2024 MPFS final was released on the day of our publication deadline.

CMS has confirmed that the 2024 MPFS conversion factor is $32.7442. The decrease from the 2023 conversion factor is 3.37 percent. Congress may yet step in to cut that decrease to closer to 2 percent, as they have in years past.

CMS estimates impact on total allowed charges for emergency medicine to be minus-2 percent with rounding in 2024.

Also, here are four MPFS proposals that are addressed in the final rule:

1. Expect Continued Flexibilities for Telehealth Services

The Centers for Medicare & Medicaid Services (CMS) plans to implement the 2023 Consolidated Appropriations Act (CAA)telehealth services provisions through the end of 2024.

The proposal also includes lifting geographic restrictions and letting Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) provide telehealth services. Audio-only telehealth service coverage and payment may also see an extension in the coming year.

2. Look for Programs Related to Equity and SDoH

Ensuring that all people receive the same level of healthcare remains a central theme post-pandemic, which isn’t surprising as the public health emergency (PHE) revealed longstanding, systemic problems.

“CMS continues to demonstrate commitment to advancing health equity and building a stronger Medicare program,” explained Meena Seshamani, MD, CMS deputy administrator and director of the Center for Medicare, in a release. “If finalized, the proposals in this rule ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs — physical health, behavioral health, oral health, social determinants of health, and are inclusive of caregivers, which are all so important to providing the care that people with Medicare deserve.”

“Building on CMS’ goal of increasing health equity, the agency has proposed coding and payment for several new services to help underserved communities,” summarized Miranda Franco, senior policy advisor, with law firm Holland & Knight LLP in an H & K Health Dose blog post. “These include certain caregiver training programs, separate coding and payment for community health integration services, payment for principal illness navigation services, and coding and payment for social determinants of health risk assessments,” Franco explained.

How profoundly these programs will impact ED practices is yet to be seen, but at the very least there is potential for continued incentive for reporting social determinants of health (SDoH).

3. Witness Another Split/Shared Policy Delay

CMS intends to keep the current split/shared rules for a little bit longer, with a start date for the new policy now slated for Jan. 1, 2025. CMS finalized implementing its split/shared policy that the provider who administers the substantive portion of the visit bills for the evaluation and management (E/M) services — whether it’s the physician or the nonphysician practitioner (NPP) — in the calendar year (CY) 2022 MPFS final rule and then delayed the implementation in the CY 2023 MPFS final rule.

Many have opposed the change since CMS first proposed the policy, so this further delay will allow CMS to gather more comments and feedback from interested stakeholders regarding the policy and how it could be altered or further refined.

4. Understand the CF Changes

In the latest proposed rule, CMS opts to reduce the overall payment rate by 1.25 percent and the CF by 3.34 percent or $1.14, decreasing the amount from the $33.89 (CY 2023) to $32.75 (CY 2024). Many hoped CMS would leave the CF, at the very least, status quo for CY 2024, but with the release of the final rule, that didn’t happen.

However, “CMS is also proposing significant increases in payment for primary care and other kinds of direct patient care,” the agency says (source: www.cms.gov/ newsroom/ fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule). The verbiage in the proposed rule does not offer an obvious indication that physicians will see a payment change that will offset the decreased conversion factor, however.

There is hope that the CF change won’t stand, however.

Note: For CYs’ 2021, 2022, and 2023, Congress stepped in with last-minute legislation to circumvent the cuts, but even its intervention was miniscule.

AMA weighs in: Physician payments have been on a downward spiral for years — and that’s a problem, warns the AMA. “When adjusted for inflation, Medicare physician payment already has effectively declined 26 percent from 2001 to 2023 before additional inflation and these cuts are factored in. Physicians are one of the only providers without an automatic inflationary increase,” explained AMA President Jesse M. Ehrenfeld, MD, MPH, in a release.

“This is almost biblical in its impact,” he argued. “Seven lean years that include a pandemic and rampaging inflation. Physicians need relief from this unsustainable journey.”