Latest Medicare Physician Fee Schedule Rule Cuts Down Payment Rates – A concerning fact for Medical Billers and Coders
For years COVID-19 public health emergency has profoundly affected many socio-economic aspects globally. Healthcare organizations and several practices rendering medical services during PHE were no exceptions.
With PHE officially coming towards its end this year, the Centers for Medicare & Medicaid Services (CMS) also has finalized and issued Medicare Physician Payment Policies for CY 2023.
In this article, we briefly touch upon the implications of this update. These latest changes post PHE directly impact the overall payment rate for many routine services that are covered under Part B.
Reduction in the conversion factor:
According to latest changes, Payment rates for Part B services will be significantly lowered through notable reduction in the value of Conversion Factor.
Conversion Factor is a key multiplier figure that Medicare applies to relative value units (RVUs) to calculate reimbursement for a particular service or procedure under Medicare's fee-for-service (FFS) system.
2023 Medicare Physician Fee Schedule includes a 4.5% decrease in the conversion factor effective 1st January
The $33.06 figure is slightly lower than the $33.08 conversion factor. This also accounts for the 0% update factor required under the Medicare Access and CHIP Reauthorization Act (MACRA), expiration of the 3% percent flat increase included in the 2022
How does this concern you?
The major financial implications of this outbreak included sudden over-burdening need of medical services, also resulting in exhaustion of the resources i.e., financial, human resource and time.
Post-PHE many effected organization and practices might have even started looking at better days to come. However, this cut in conversion factor will perhaps cause hindrance for an already financially weakened practice to re-grow and finally bounce back to health.
CMS also reported changes made to the services also Includes Inpatient/Outpatient E/Ms, Behavioral health services, HHAs, telehealth services, prolonged services and few others routine services. With this proposed rule medical groups won’t be faring well with this new update any time soon.
What to expect?
The loss in revenue expected with this change is coming with a plausible concern. Industry pioneers and providers are already discussing the proposed cuts and demanding for congressional involvement in this matter.
Industry experts showed their concern as that this payment rule might also come with reduced quality access to care in various specialties across the board.
Access to healthcare facilities at a lower cost would definitely benefit Medicare and its patients. However, some practices that were already hit hard by PHE might struggle to keep their doors open. Also, taking account of the flexibilities and waivers offered to the beneficiaries during the times of PHE.
AltuMED is a Healthcare Revenue Cycle Management technology and solutions company. Our technologically advanced Practice Management Software, PracticeFit optimizes the Medical Billing workflows for Medical Practices, Labs and Third-Party Medical Billing Companies helping them collect maximum revenue. Find out more.
Subscribe to Our Newsletter!
Subscribe to Our Newsletter!
Enter Your Email Address. We Promise We Won't Spam You
Relevant Articles
Categories
Informational
Educational
Medical Billing Software
Follow Us