The Centers for Medicare & Medicaid Services today released on its website its calendar year 2023 final rule for the physician fee schedule. The rule will cut the conversion factor to $33.06 in CY 2023 from $34.61 in CY 2022, which reflects the expiration of the temporary 3% statutory payment increase; a 0.00% conversion factor update; and a budget-neutrality adjustment. In addition, CMS will delay for one year (until Jan. 1, 2024) implementing its policy to define the substantive portion of a split (or shared) visit based on the amount of time spent by the billing practitioner. Under this policy, if a non-physician practitioner performed at least half of an Evaluation and Management (E/M) visit and billed for it, Medicare will only pay 85% of the PFS rate.

CMS also made updates to several policies for telehealth and opioid treatment programs. For telehealth, the final rule makes available at least through CY 2023 several services temporarily available as telehealth services for the COVID-19 public health emergency, and updates the originating site facility fee for CY 2023. The final rule also updates opioid treatment program payment rates.

CMS finalized numerous policy changes to the Medicare Shared Savings Program. For example, it will modify the manner in which accountable care organizations' benchmarks are calculated to help sustain long-term participation and reduce costs. It also will provide increased flexibility for certain smaller ACOs to share in savings. In addition, the rule updates MSSP quality measurement policies, including a new health equity adjustment that will award bonus points to ACOs serving higher proportions of underserved and dual-eligible beneficiaries.

For the Quality Payment Program, CMS made available beginning in 2023 five new optional Merit-based Incentive Payment System Value Pathways, in addition to revising seven previously established MVPs. These MVPs align the reporting requirements of the four MIPS performance categories around specific clinical specialties, medical conditions or episodes of care. CMS also made refinements to the MIPS subgroup reporting process, including an increase to the quality data completeness threshold, and made changes to the requirements and scoring of the Promoting Interoperability category. For advanced Alternative Payment Models, the final rule permanently establishes the 8% minimum General Applicable Nominal Risk standard, which was originally set to expire in 2024, and specifies that the 50 eligible clinician limit for Medical Home Models applies to the APM Entity participating (as defined by Taxpayer Identification Numbers/National Provider Identifiers on the APM entity’s participation list).

AHA members will receive a Special Bulletin with more details. We anticipate the final rule will be published in the Federal Register in the coming days.

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