Tag - Physician Fee Schedule

By the start of November, the Center for Medicare and Medicaid Services (CMS) published a conclusive rule on the physician payment program. The policy exhibits a significant shift towards a better administrative approach at the time of the global pandemic. 

The payment program for the calendar year 2022 not only improves the reimbursement.But the emphasis on the Telehealth system will promote accessibly and empower the health care system with innovation.

Overview of The Physician Fee Schedule (PFS)

Funded by Part B the center for medicare and Medicaid Services uses a physician fee schedule plan to reimburse the health care experts for the services they render. It covers a variety of contexts that cover physician offices, clinical labs and aids other beneficiaries of the health practice. 

Medicare paid the health professional on a particular valuation based on the resources applied in aiding the patient. While the PFS is based on the division of means that are used in rendering the services.

So, the payment method is based on relative resources.RVU( Relative value unit) 

Works at the fixed dollar rate, geographical characteristics are considerable due to the variation in payments across different geographical localities. 

Payment Terms

PFS ultimate rules strive to promote health equality, assuring accessibility and introducing unorthodox solutions to tackle the upcoming challenges in the health care system.

Here are some of the key requirements in the payment method. 

Telehealth

There are principal policy shifts that occur in this sector. The initial and significant shift was the elimination of geographical restrictions for patients having a psychological disorder through the 2021 Act of consolidated appropriation (CAA).

CMA finalized its terms to the amount that there should be a face-to-face interaction within six months earlier than the virtual interaction. 

The ultimate rule obliges the Secretary to arrange a frequent in-person interaction.

CMS also retained some services due to the COVID-19 public health emergency. It extended the duration till 2023 so that more data can be collected.

CMS is also creating shifts in an interactive telecommunication system. Now the home-based mental health service providers who have the ability to provide the service through two ways, audio as well as video can use only audio technology under beneficiary preference or due to some restrictions. This audio can also be tracked by using modifiers. 

Evaluation and Management Visits (E/M) Visits

Evaluation and management visits are conducted in sections by the physicians and non-physicians providers (NPP). CMS extended the scope of E/M visits by ensuring that only E/M visits were provided in the facility by physicians and NPP in the same group. 

The new measures suggest that physicians or NPP who reach the substantive portion would bill for it. Documentation and modifiers are used for the settlement of existing policy and the indication of split/shared visits. 

CMA also furnished a package of services to critical care settings. These services asked full attention from physicians and NPP, on the same day when more than one physician is needed.

The visit may be considered as split and shared and payment should be issued at the same time.

Practitioners are aimed to document, entire time each practitioner served for the patient care and their role and attest that those services were essential and medically approved.

For the teaching facility services, only the time which is used for qualifying purposes will be counted as E/M visit level.

Rural Health Clinics and Federally Qualified Health Centers

CMS settled multiple provisions to facilitate RHC and FQHCs.Including telehealth services paid at the same rate as the in-house services and allowing mental health telehealth visits using only audio interaction in special cases based on beneficiary preferences and limitations. 

Covid-19 PHE flexibility accommodates a temporary authority to pay RHC & FQHC for a distant telehealth facility. That will expire after the PHE ends. 

Drug Pricing Reporting

CMS defines drugs as a product, service, supply that is payable under Part B. Under some regulations, drug manufacturing companies are asked to submit average sales price data which covers their part B product. These regulatory changes are imposed to implement CAA’s requirements.

Open Payment Program

An open payment program is a public disclosure of medical records to maintain transparency and accountability. It eventually tells the financial relationship between the drug manufacturing, medical service provider, and other medical equipment manufacturers. 

• CMS settled multiple amendments that will eventually expedite data collection.
• A mandatory payment context field will be used to collect essential data. 
• Restricted the elimination of data without giving any proper reason. 
• In case when no data have been recorded then an option of recertification exists.
• Making it mandatory to publicize the payment record without any delay. 
• The eligibility to submit general payment records is removed so that all entities are liable to submit up-to-date reportable data with ownership records. 

For more relevant information, see the fact sheet published by the Centre for Medicare & Medicaid Services.