The Centers for Medicare & Medicaid Services Nov. 1 released its calendar year 2025 final rule for the physician fee schedule. The rule will cut the conversion factor by 2.8% to $32.35 in CY 2025 compared to $33.29 in CY 2024. This reflects the expiration of the 2.93% statutory payment increase for CY 2024; a 0.00% conversion factor update under the Medicare Access and CHIP Reauthorization Act; and a .02% budget-neutrality adjustment. 

In addition, CMS extended several regulatory telehealth waivers through 2025. These include waivers for reporting of enrolled practice addresses instead of home addresses when providers perform services from their homes; another for Federally Qualified Healthcare Centers and Rural Health Clinics to bill for telehealth services; and another allowing virtual supervision for residents in all teaching settings when the services are provided virtually. The agency also updated the definition of an interactive telecommunications system to include two-way, audio-only communication for any Medicare telehealth service furnished to a beneficiary in their home (if the beneficiary is incapable or does not consent to video technology). Finally, CMS notes, absent congressional action, statutory limitations in place for Medicare telehealth services prior to the COVID-19 public health emergency will again take effect on Jan. 1.

The agency also finalized several proposals related to the reporting and returning of Medicare Parts A and B overpayments. Specifically, CMS finalized circumstances that would suspend the deadline for reporting and returning overpayments to allow time for providers to investigate and calculate overpayments.

For the Quality Payment Program, CMS adopted six new, optional Merit-based Incentive Payment System Value Pathways for reporting beginning in 2025. For the Medicare Shared Savings Program, CMS finalized policies to mitigate the impact of significant, anomalous, and highly suspect billing activity for CY 2024 and subsequent years. Specifically, CMS will exclude payment amounts from financial calculations for the relevant CY for which the SAHS billing activity is identified and from historical benchmarks used for reconciliation.

AHA members will receive a Special Bulletin with more details Nov. 4.

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