2022 MPFS Final Rule: Part 3 Final Highlights for Anesthesia and Pain Providers

In this final installment of our review of the 2022 Medicare Physician Fee Schedule, we address some of the remaining topics that may be of interest to either anesthesia or chronic pain providers. This includes some possible good news on the reimbursement front.

In our first two alerts dealing with last month's release of the 2022 Medicare Physician Fee Schedule (PFS) Final Rule (FR), we provided details that would be of particular interest to anesthesia and chronic pain providers. Today's alert reflects the final highlights arising from the FR that may have some pertinence to these specialties. 

Physician Assistant Services 

Medicare will now be making direct payment to physician assistants (PAs) for professional services that they furnish under Part B, beginning January 1, 2022. This is a first and it's a big deal. Medicare currently makes payment to the employer or independent contractor of a PA. Beginning next month, PAs will be able to bill Medicare directly for their professional services or reassign payment for their professional services. 

According to a fact sheet published by the Centers for Medicare and Medicaid Services (CMS), this means that PAs can now incorporate with other PAs and bill Medicare for their services. Again, this is a significant change for this provider type. 

Screening Colonoscopy 

Beginning January 1, 2022, the coinsurance amount, i.e., "copay," related to a planned colorectal cancer screening test that requires additional related procedures "shall be equal to a specified percent (i.e., 20 percent for 2022, 15 percent for 2023 through 2026, 10 percent for 2027 through 2029, and zero percent beginning 2030) of the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to the test." 

All this means that a Medicare patient's copay for a screening colonoscopy that results in an interventional procedure (e.g., biopsy, polypectomy) furnished in the same clinical encounter will be gradually reduced over the next few years; and, in 2030, that copay will be completely eliminated. In 2022, our clients should continue to document any interventions performed by the endoscopist during a screening colonoscopy session (e.g., biopsy, polypectomy). 

Opioid Treatment Program 

The 2022 FR allows opioid treatment programs (OTPs) to furnish counseling and therapy services via audio-only interaction (such as telephone calls) after the conclusion of the COVID-19 public health emergency (PHE). However, this allowance is only in cases where audio/video communication is not available to the beneficiary, including circumstances in which the beneficiary is not capable of, or does not consent to the use of, devices that permit a two-way audio/video interaction. This assumes all other requirements for audio interaction are met. 

Electronic Prescribing of Controlled Substances 

Section 2003 of the SUPPORT Act requires electronic prescribing of controlled substances (EPCS) for schedule II, III, IV, and V controlled substances covered through Medicare Part D. The statute provides the secretary of Health and Human Services (HHS) with discretion on whether to grant waivers or exceptions to the EPCS requirement and specifies several types of exceptions that may be considered. It also gives the HHS secretary authority to specify appropriate penalties for non-compliance through future rulemaking. 

• The 2022 FR finalizes certain exceptions to the EPCS requirement. An exception will apply if a prescriber meets any of the following: 
• The prescriber and dispensing pharmacy are the same entity; 
• The prescriber issues 100 or fewer controlled substance prescriptions for Part D drugs per calendar year; and 
• The prescriber is in the geographic area of an emergency or disaster declared by a federal, state or local government entity, or 
• The prescriber has been granted a CMS-approved waiver based on extraordinary circumstances, such as technological failures or cybersecurity attacks or other emergency. 

CMS is allowing prescribers to request a waiver where circumstances beyond the prescriber's control prevent the prescriber from being able to electronically prescribe controlled substances covered by Part D. The agency is also delaying the start date for compliance actions to January 1, 2023. 

Provider Enrollment 

The FR ended up approving all of the measures concerning provider enrollment that were first published in the PFS Proposed Rule for 2022. These include the following: 

• Exemption of independent diagnostic testing facilities (IDTF) that only perform services that do not require direct or in-person beneficiary interaction, treatment, or testing from several of Medicare's IDTF supplier standards in 42 CFR § 410.33. 
• Expansion of CMS' authority to deny or revoke a provider's Medicare enrollment in order to protect the Medicare program and its beneficiaries. 
• Establishment of specific rebuttal procedures for providers whose Medicare billing privileges have been deactivated. 

For more detailed information regarding any of the above provisions of the 2022 PFS Final Rule, we recommend you review the full document, which can be accessed here. 

Reimbursement Update 

On December 9, the U.S. Senate passed legislation that would halt the 2 percent sequestration deduction in provider reimbursement that had been set to go into effect next month. The House of Representatives had passed the bill earlier in the week. The measure is expected to be signed into law by the president. 

Specifically, the bill extends the moratorium on the 2 percent Medicare sequester cut until April 1, 2022. It then reduces the cut to 1 percent from April 1 through June 30, 2022. In addition, the bill would quash the 4 percent statutory Pay-As-You-Go sequester from taking effect next year. Finally, the legislative package addresses the reduction in the 2022 PFS conversion factor (CF) set by the PFS Final Rule (FR). Based on a review of several news outlets, it is uncertain what the new PFS CF will be, though it will clearly be better than what the 2022 FR had published. Here is a representative statement regarding what the new legislation would mean for the 2022 PFS CF: "Increase payments on the Medicare Physician Fee Schedule by 3% in 2022. The amount is 0.75% less than the 3.75% increase the fee schedule received for 2021." 

Should this legislation be signed into law, as expected, it should make for a merrier holiday season and new year for our readers. If you have questions for us about the above topics, please contact your account executive or reach out to us at info@anesthesiallc.com. 

With best wishes, 

Tony Mira 

President and CEO