MD/DO’s Line Up for 5% Medicare Fee Cut

[drusso]

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CMS has published its annual payment updates for physicians, the Medicare shared savings program and outpatient and home health services for 2023.

Here are 15 takeaways from the final rules, published Oct. 31 and Nov. 1:

Physician Fee Schedule rule

1. The conversion factor used to calculate physician reimbursement will decline by $1.55 to $33.06 in 2023, representing a 4.48 percent decrease. CMS said the conversion factor accounts for the expiration of the 3 percent increase in physician fee schedule payments for 2022 — as required by the Protecting Medicare and American Farmers From Sequester Cuts Act — and the budget neutrality adjustment for changes in relative value units.

Meanwhile, HOPD and ASC SOS rates go up.

People don’t like to hear it, but “elections have consequences,” and “they will never love you back.” Let your specialty societies know that cutting fees jeopardizes patient care or just vote with your feet.

If you think that the Feds have your back, “government works,” and “socialized medicine is the answer” then you’re not paying attention.

 

[Analgesia108]

Here's
Chronic Pain Management and Treatment Services

We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. We believe the CPM HCPCS codes will improve payment accuracy for these services, prompt more practitioners to welcome Medicare beneficiaries with chronic pain into their practices, and encourage practitioners already treating Medicare beneficiaries who have chronic pain to spend the time to help them manage their condition within a trusting, supportive, and ongoing care partnership.

The finalized codes include a bundle of services furnished during a month that we believe to be the starting point for holistic chronic pain care, aligned with similar bundled services in Medicare, such as those furnished to people with suspected dementia or substance use disorders. We have finalized the CPM codes to include the following elements in the code descriptor: diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy, complementary and integrative care approaches, and community-based care, as appropriate.

 

[callmeanesthesia]

Here's
Chronic Pain Management and Treatment Services

We finalized new HCPCS codes, G3002 and G3003, and valuation for chronic pain management and treatment services (CPM) for CY 2023. We believe the CPM HCPCS codes will improve payment accuracy for these services, prompt more practitioners to welcome Medicare beneficiaries with chronic pain into their practices, and encourage practitioners already treating Medicare beneficiaries who have chronic pain to spend the time to help them manage their condition within a trusting, supportive, and ongoing care partnership.

The finalized codes include a bundle of services furnished during a month that we believe to be the starting point for holistic chronic pain care, aligned with similar bundled services in Medicare, such as those furnished to people with suspected dementia or substance use disorders. We have finalized the CPM codes to include the following elements in the code descriptor: diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy, complementary and integrative care approaches, and community-based care, as appropriate.

I’m a little unclear on these codes - are they an add-on to E&M or do they replace billing for office visits?

 

[IAmTheOne1]

Still somewhat unclear even after all these pages. Apparently you CAN bill both the E/M and the G code but there can’t be any overlap? So for pain doc, this will be impossible. So can we just bill E/M? Cause the RVU for these G codes is WAY lower than a 99214.

 

[FatJoe]

Yeah I agree this is still confusing which is not surprising given the arbitrary nature of CMS. Per my interpretation I think we will all continue to just use e/m coding. They make the point that they expect this to be used mainly by PCPs but I don’t see a future where anyone is going to use this code given that it requires a 30 minute face to face time for ~1.4 wRVU, compared to 1.92 for a level 4 fuv. This issue was brought up in the comments and they completely glossed over and justified their valuation with a “because I said so”

 

[voxveritatisetlucis]

joke

 

[Ducttape]

CMS has published its annual payment updates for physicians, the Medicare shared savings program and outpatient and home health services for 2023.

Here are 15 takeaways from the final rules, published Oct. 31 and Nov. 1:

Physician Fee Schedule rule

1. The conversion factor used to calculate physician reimbursement will decline by $1.55 to $33.06 in 2023, representing a 4.48 percent decrease. CMS said the conversion factor accounts for the expiration of the 3 percent increase in physician fee schedule payments for 2022 — as required by the Protecting Medicare and American Farmers From Sequester Cuts Act — and the budget neutrality adjustment for changes in relative value units.

Meanwhile, HOPD and ASC SOS rates go up.

People don’t like to hear it, but “elections have consequences,” and “they will never love you back.” Let your specialty societies know that cutting fees jeopardizes patient care or just vote with your feet.

If you think that the Feds have your back, “government works,” and “socialized medicine is the answer” then you’re not paying attention.

hilarious to blame the current congress for this act.

you do know why this act was passed, right?

the act was passed to avoid the mandatory cuts to Medicare that were supposed to be enforced as of Jan 1, 2022.

Bipartisan Legislation to Address Medicare Cuts Enacted

Congress passed and President Joe Biden signed into law last week the Protecting Medicare & American Farmers from Sequester Cuts Act. The new law addresses several Medicare provider payment cuts slated to go into effect on January 1, 2022. Amo...

www.gnyha.org

Congress Passes Legislation to Avoid Medicare Provider Payment Cuts

Congress passed legislation to avoid scheduled Medicare provider payment cuts.

www.aamc.org

https://www.aans.org/en/DC-E-News/2021/December-E-News/Congress-Passes-Legislation-to-Prevent-Steep-Medicare-Payment-Cuts

Before adjourning, Congress passed, and President Biden signed into law the Protecting Medicare and American Farmers from Sequester Cuts Act (P.L. 117-71) — legislation that would avert steep Medicare payment cuts scheduled to take effect on Jan. 1. Neurosurgeons had anticipated cuts of 9% or more due to several factors:

• Expiration of the 3.75% payment adjustment to the Medicare Physician Fee Schedule (MPFS) conversion factor (CF);
• Expiration of the moratorium on the 2% Medicare payment sequester; and
• Implementation of a 4% statutory Pay-As-You-Go (PAYGO) Act cut.

During the year, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) led several coalition efforts, including the Surgical Care Coalition, to advocate for legislation to prevent these cuts. The final package incorporated the following relief to mitigate the cuts:

• A one-year 3% increase in the Medicare CF to offset the expiration of the MPFS 3.75% payment adjustment;
• A delay in resuming the 2% Medicare sequester cut for three months (Jan. 1–March 31), followed by a reduction to 1% for three months (April 1–June 3); and
• A one-year delay of the 4% PAYGO cuts.

clear example of misplaced blame, and then stating elections have consequences. well, the consequences is that we got 1 year reprieve from these mandatory cuts. "The bill comes due" - Karl Mordo.

 

[drusso]

hilarious to blame the current congress for this act.

you do know why this act was passed, right?

the act was passed to avoid the mandatory cuts to Medicare that were supposed to be enforced as of Jan 1, 2022.

Bipartisan Legislation to Address Medicare Cuts Enacted

Congress passed and President Joe Biden signed into law last week the Protecting Medicare & American Farmers from Sequester Cuts Act. The new law addresses several Medicare provider payment cuts slated to go into effect on January 1, 2022. Amo...

www.gnyha.org

Congress Passes Legislation to Avoid Medicare Provider Payment Cuts

Congress passed legislation to avoid scheduled Medicare provider payment cuts.

www.aamc.org

https://www.aans.org/en/DC-E-News/2021/December-E-News/Congress-Passes-Legislation-to-Prevent-Steep-Medicare-Payment-Cuts

clear example of misplaced blame, and then stating elections have consequences. well, the consequences is that we got 1 year reprieve from these mandatory cuts. "The bill comes due" - Karl Mordo.

Physicians rally to avert Medicare payment cuts

The federal government is officially reducing Medicare payments to physicians next year by 4.5%, but doctors and their lobbyists are ready to blitz Congress to avert the cuts.

www.statnews.com

"Physicians believe the disparities in federal rules are making it more difficult for them to practice medicine on their own. Medicare factors rising inflation into both hospital inpatient and outpatient services, but not physician services, which critics say pushes physicians to sell to hospitals if it means the same services they provide in their offices will be worth double, or more, just by switching ownership. “That creates a perverse incentive to perform the same care and tests in a more expensive setting,” Joy said. “And it just leads to this huge gap when we have record-setting inflation and nothing to fix it.”

SOS is the root of all evil in our health care system.

 

[Ducttape]

moving goalposts again....

blaming congress didnt work. go back to SOS...

 

[drusso]

moving goalposts again....

blaming congress didnt work. go back to SOS...

It's all related. Why do you think the status quo exists? Hint: It's not a fluke.

 

[Ducttape]

maybe. but it is poor form to make bold statements on misrepresented information then change the argument to a different aspect.

Red Herring Fallacy or misdirection.

 

[drusso]

maybe. but it is poor form to make bold statements on misrepresented information then change the argument to a different aspect.

Red Herring Fallacy or misdirection.

What do you dispute?

 

[Ducttape]

stop changing the premises of your post.

stop moving the goalposts.

 

[drusso]

stop changing the premises of your post.

stop moving the goalposts.

That's not a topic for discussion.

 

[10KHertz]

That's not a topic for discussion.

Drusso why waste your energy trying to explain healthcare policy and politics to this forum? Lost cause my friend .Most never owned their own practices and actually experienced the massive ACA cuts… they are clueless really.
CMS will continue to slash specialists rates. It’s the president’s responsibility to select a CMS director to halt them and reassess .

 

[drusso]

Drusso why waste your energy trying to explain healthcare policy and politics to this forum? Lost cause my friend .Most never owned their own practices and actually experienced the massive ACA cuts… they are clueless really.
CMS will continue to slash specialists rates. It’s the president’s responsibility to select a CMS director to halt them and reassess .

I guess I earnestly cling to the idea of a "growth mindset." IF only people knew...

 

[Fpg1245]

Drusso why waste your energy trying to explain healthcare policy and politics to this forum? Lost cause my friend .Most never owned their own practices and actually experienced the massive ACA cuts… they are clueless really.
CMS will continue to slash specialists rates. It’s the president’s responsibility to select a CMS director to halt them and reassess .

It’s pretty much malice at this point.

 

[Ducttape]

we understand healthcare policy much better than he is aware.

unfortunately, there is more than 1 side of the story, as it were.

there are significantly more other "shareholders" in the picture than the limited group of private practice owners that he is advocating for.

 

[drusso]

we understand healthcare policy much better than he is aware.

unfortunately, there is more than 1 side of the story, as it were.

there are significantly more other "shareholders" in the picture than the limited group of private practice owners that he is advocating for.

I'm not advocating for a group of stakeholders. I'm advocating for a set of principles.

 

[GlowInTheDark]

I’m a little unclear on these codes - are they an add-on to E&M or do they replace billing for office visits?

No, you can’t bill an E/M and this code.

It literally makes no sense. Requires 30 minutes of time and RVU is something like 1.48.

Complex enough E/M which most our patients make renders this code complete meaningless.

 

[lobelsteve]

No, you can’t bill an E/M and this code.

It literally makes no sense. Requires 30 minutes of time and RVU is something like 1.48.

Complex enough E/M which most our patients make renders this code complete meaningless.

I think you are mistaken.

 

[GlowInTheDark]

I think you are mistaken.

I will absolutely accept correction, this was my interpretation after reading through the CMS FY 2023 document using “search”. Definitely waiting for our coders/billers to translate for me.

 

[lobelsteve]

I will absolutely accept correction, this was my interpretation after reading through the CMS FY 2023 document using “search”. Definitely waiting for our coders/billers to translate for me.

https://forums.studentdoctor.net/threads/cms-and-chronic-pain-management-codes-g3002-g3003.1471475/