2022 Medicare Physician Fee Schedule – 5 things you need to know
On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022.
CMS is proposing several provisions that are intended to help Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) provide care to underserved Medicare beneficiaries. Comments on the proposed rule are due Sept. 13.
COVID-19 Public Health Emergency (PHE) Extensions
CMS is proposing a temporary extension of certain services added to the Medicare telehealth list during COVID-19 PHE. The proposed extension to December 31, 2023, would allow time to collect data and evaluate whether the services should be permanently added to the telehealth list.
Mental Health Services furnished via Telecommunications Technologies for RHCs and FQHCs
The proposed rule includes changes to the current regulations for RHC or FQHC mental health visits to include visits using interactive, real-time telecommunications technology. This change would allow RHCs and FQHCs to report and receive payment for appropriate telehealth visits in the same way they currently do when visits take place in-person, including audio-only visits when the beneficiary is not capable of or does not consent to, the use of video technology.
Rural Health Clinic (RHC) Payment Limit Per-Visit
Section 130 of the CAA as amended by section 2 of P.L. 117-7, requires that beginning April 1, 2021, independent RHCs and provider-based RHCs in a hospital with 50 or more beds receive an increase in their payment limit per visit over an 8-year period, with a prescribed amount for each year from 2021 through 2028. Then, in subsequent years, the limit is updated by the percentage increase in Medicare Economic Index (MEI). Also beginning April 1, 2021, section 130 as amended requires that a payment limit per visit be established for smaller provider-based RHCs enrolled before January 1, 2021. Lastly, section 130 of the CAA subjects all newly enrolled RHCs (as of January 1, 2021, and after), both independent and provider-based, to a national payment limit per visit.
Payment for Attending Physician Services Furnished by RHCs or FQHCs to Hospice Patients
The CMS proposal to implement section 132 of the CAA, will make FQHCs and RHCs eligible to receive payment for hospice attending physician services when provided by an FQHC/RHC physician, nurse practitioner, or physician assistant who is employed or working under contract for an FQHC or RHC but is not employed by a hospice program, starting January 1, 2022.
Requiring Certain Manufacturers to Report Drug Pricing Information for Part B
In order for their covered outpatient drugs to be payable under Part B, manufacturers with Medicaid Drug Rebate Agreements are required to submit Average Sales Price (ASP) data for their Part B products. Manufacturers without agreements have the option to voluntarily submit ASP data. For calendar quarters beginning January 1, 2022, the CAA requires manufacturers of drugs or biologicals payable under Part B without a Medicaid Drug Rebate Agreement to report ASP data. CMS is proposing to make regulatory changes to implement the new reporting requirements.