Part B News | Part B News

Pay cuts looming, advocacy groups turn to lawmakers for reprieve

11/14/2022

The final 2023 Medicare physician fee schedule that CMS released Nov. 1 confirmed a harsh reality: Medical groups will see a 4.5% cut to the conversion factor (CF) on Jan. 1, 2023, as the CF falls to a rate of $33.06 and sends some charges under the Part B payment system tumbling.

CMS poised to accept most 2023 E/M revisions, with a few asterisks

11/14/2022

by: Laura Evans, CPC

As practices adjust to the AMA’s updated E/M guidelines for visits in facilities and residential settings, Medicare won’t present you with many unpleasant surprises.

CMS creates 3 new prolonged codes, won’t assign frequency limits

11/14/2022

by: Julia Kyles, CPC

Practices that report E/M services based on time could have to juggle up to six prolonged service codes in 2023 depending on where providers treat patients and on individual payer policy. CMS finalized three new prolonged service codes that will be reported based on the setting for the primary service — G0316, G0317 and G0318 — and issued additional policies for prolonged service codes.

Prolonged service threshold chart

11/14/2022

by: Julia Kyles, CPC

Share this prolonged service code chart with coders to ensure accurate claims. The first column lists the primary E/M code, followed by the add-on HCPCS code that pairs with the primary code. The threshold column contains the minimum time required to report one unit of the add-on code.

CMS extends its split/shared exception for facility-based visits

11/14/2022

by: Julia Kyles, CPC

Practices have another year to determine whether a physician or qualified health care professional bills a level-based split/shared visits based on performance of a key component of the encounter — history, physical exam or medical decision-making (MDM).

QPP changes arrive, as later reporting, payment hassles loom

11/14/2022

by: Roy Edroso

Take stock of a series of annual updates to the Quality Payment Program (QPP) and Merit-based Incentive Payment System (MIPS) to succeed in 2023, but watch carefully as CMS prepares for a whole new MIPS paradigm and, for alternative payment model (APM) participants, a possible year without bonuses down the road.

Shared Savings offers rewards for ACOs in underserved areas, but others can benefit

11/14/2022

by: Roy Edroso

By finalizing most of its proposed changes to the Medicare Shared Savings Program (MSSP), CMS is giving massive breaks to new and low-revenue accountable care organizations (ACO) that serve underserved communities, as well as enticements for others to stay. The agency evidently wants to bulk up enrollment, and some experts think it’s worth a try.

Fee schedule round-up: More policy updates coming your way

11/14/2022

by: DecisionHealth Staff

Don’t miss out on additional regulatory changes contained in the final 2023 Medicare physician fee schedule, from global period E/M visits to supply cost revisions and more.

Most specialties projected to lose charges in 2023: Fee schedule

11/14/2022

by: Richard Scott

The number of specialties welcoming a boost to their allowed charges in 2023 is far outpaced by those facing projected cuts, according to relative value unit (RVU) revisions announced in the final 2023 Medicare physician fee schedule released Nov. 1.

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