General Surgery Coding Alert

You heard the outcry over impending Medicare payment cuts for 2023, now you need to know how the feds acted at the end of 2022 to offer healthcare providers, including surgeons, some relief.

Action: On Dec. 29, 2022, President Biden signed the Consolidated Appropriations Act, 2023 (CAA) into law, offsetting impending 2023 Medicare payment cuts.

Study the following four items included in the CAA 2023 that will help your surgery practice’s bottom line this year.

Grasp Conversion Factor (CF) Relief

Last year, Medicare finalized cutting the 2023 CF by 4.5 percent, from $34.61 to $33.08. Instead, the CAA offers a two-pronged approach spanning two payment cycles. “The bill would offset the planned cuts by more than 2 percent, providing a 2.5 percent positive adjustment to the CF for calendar year (CY) 2023, and a 1.25 percent positive adjustment to the CF for CY 2024,” explains McDermott+Consulting, an affiliate of law firm McDermott Will & Emery, in a bill summary.

Not enough: Stakeholders weren’t impressed. “The AMA is extremely disappointed and dismayed that Congress failed to prevent Medicare cuts next year, threatening the financial viability of physician practices and endangering access to care for Medicare beneficiaries,” says Jack Resneck Jr., MD, president, American Medical Association (AMA) in a release. “This 2 percent cut following two decades of flat payment rates will have consequences on health care access for older Americans. High inflation compounds the threat to practice viability because physicians are the only Medicare providers without annual inflation-based updates,” he adds.

Expect Delay of PAYGO Cuts

The CAA offers some relief from the scheduled Pay-As- You-Go (PAYGO) Medicare sequester by preventing the cuts in 2023 and 2024.

“The Statutory PAYGO requires that automatic payment cuts of 4 percent be put into place if a statutory action is projected to create a net increase in the deficit over either five or 10 years,” according to McDermott+Consulting. In fact, “the PAYGO sequester has never actually been implemented despite being triggered on multiple occasions,” it notes.

Last December, Congress postponed PAYGO cuts for a year in its omnibus spending package. Based on this year’s CAA, that relief will now last two years.

“The CAA 2023 would ‘wipe the PAYGO scorecard clean’ for FY 2023 and FY 2024,” McDermott+Consulting states. But “Congress likely will have to contend with PAYGO obligations again in two years,” it cautions.

Look for MACRA Opportunity

Providers can opt for the higher incentive payment route under MACRA — Advanced Alternative Payment Models (APMs). One of the omnibus bill provisions extends the incentive payment boost, which was scheduled to end in 2022, for providers who choose the APM track through the 2023 performance year/2025 payment year.

Caveat: Though the extension is helpful, the legislation reduces the incentive bonus to 3.5 percent for providers who qualify for it, instead of 5 percent, which is what it was set at in previous payment years.

Extend Your Telehealth Flexibilities

After allowing providers to serve patients without in-person contact by using telehealth during the COVID-19 pandemic, the feds have taken further action regarding telehealth rules in both CAA 2022 and CAA 2023.

Background: Options to use telehealth services were originally tied to the end of the COVID-19 public health emergency (PHE) and would automatically expire with the PHE. But last year, CAA 2022 unlinked this expiration provision and ruled to extend most telehealth options for 151 days after the PHE expiration.

CAA 2023: Instead of tying telehealth expiration to the PHE at all, CAA 2023 extends provider’s options for certain telehealth services through December 31, 2024. Specifically, the extension applies to the following telehealth concerns:

• Allowing audio-only telecommunications
• Allowing telehealth in place of required face-to-face encounter for hospice recertification
• Waivers for geographic and originating site restriction
• Expanded eligible practitioner list
• Federally qualified and rural health center eligibility

CAA 2023 also tasks the US Department of Health and Human Services (HHS) with conducting a study on telehealth and Medicare program integrity. HHS should file an interim report of findings by October 1, 2024 and a final report by April 1, 2026.

Resource: Review the CAA at www.appropriations.senate.gov/ imo/media/doc/JRQ121922.PDF.