2022 MPFS Final Rule: Part 2

Summary: Today's alert continues our summary of the changes in store next year for Medicare providers. Highlights include chronic pain coding changes, modifications to the teaching rules and quality standards.

Provider Relief Fund Reporting Deadline: November 30, 2021
A reminder that if you received Provider Relief Fund (PRF) payments totaling more than $10,000 between April 10th, 2020 and June 30th, 2020, you must report via the PRF Reporting Portal by November 30, 2021 at 11:59 pm ET to avoid further enforcement actions like repayment or other debt collection activities.

A couple of weeks ago, we reviewed for our readers some of the major provisions of the 2022 Medicare Physician Fee Schedule (MPFS) Final Rule (FR), including a look at the new conversion factors (CFs), evaluation and management (E/M) changes, and modifications to the critical care rules. Today's article will summarize additional areas of the FR that particularly pertain to our anesthesia and chronic pain clients. 

Chronic Pain Codes

The FR lists two new codes related to basivertebral lesioning. In addition, the FR lists the work relative value units (RVUs) for facet joint denervation (codes 64633-64636). These are detailed in the following chart, provided by the American Society of Anesthesiologists (ASA).  

Those working in chronic pain practices will want to make note of the new basivertebral destruction codes and keep in mind that they bundle imaging. You can't bill separately for the fluoroscopy.

Teaching Physician Services

The current E/M coding framework, as envisioned by the American Medical Association (AMA) and approved by the Centers for Medicare and Medicaid Services (CMS), allows providers to select the overall office/outpatient E/M visit level based on either the level of medical decision making (MDM) or the total time personally spent by the reporting practitioner. Under the existing regulations, if a resident participates in a service furnished in a teaching setting, a teaching physician can bill for the service only if they are present for the key or critical portion of the service. Under the "primary care exception," in certain teaching hospital primary care centers, the teaching physician can bill for certain services furnished independently by a resident without the physical presence of a teaching physician, but with the teaching physician's review.

Within the 2022 FR, CMS clarified that when time is used to select the office/outpatient E/M visit level, only the time spent by the teaching physician in qualifying activities, including time that the teaching physician was present with the resident performing those activities, can be included for purposes of visit level selection. Under the primary care exception, time cannot be used to select visit level. Only MDM may be used.

Telehealth Services

The FR finalizes the inclusion of certain services added temporarily to the telehealth services list that would otherwise have been removed from the list as of the later of the end of the COVID-19 PHE or December 31, 2021. Those services will now be covered until the end of 2023.

Pursuant to the provisions of Section 123 of the Consolidated Appropriations Act (CAA), the FR finalizes that:

• An in-person, non-telehealth visit must be furnished at least every 12 months for services otherwise allowed to be performed via telehealth.
  
  
• Exceptions to the in-person visit requirement may be made based on beneficiary circumstances (with the reason documented in the patient's medical record).
  
  
• More frequent visits are also allowed under the policy, as driven by clinical needs on a case-by-case basis.

The FR amends the definition of interactive telecommunications system for telehealth services (currently defined as multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant-site practitioner) to include "audio-only communications technology when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes under certain circumstances. In other words, CMS is limiting the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications, but where the beneficiary is not capable of, or does not consent to, the use of two-way, audio/video technology.

Quality Provisions

The 2022 FR provides details on how the Merit-based Incentive Payment System (MIPS), MIPS Value Pathways (MVPs), Alternative Payment Models (APMs) and other features of the Quality Payment Program (QPP) will operate during the 2022 performance year and beyond.

According to the ASA, CMS finalized the anesthesiology MVP for the 2023 reporting year. In 2022, QPP participants will see some modifications to the program, including:

• The MIPS performance threshold will be set at 75 points with an exceptional performance bonus applied to those individuals and groups scoring over 89 points. Individuals and groups receiving less than 75 points will incur a payment penalty on a sliding scale up to 9 percent in 2024, with those scoring under 18.75 points incurring an automatic -9 percent adjustment.
  
  
• The quality and cost performance categories will be equally weighted at 30 percent of the total MIPS score. Promoting interoperability and Improvement Activities performance categories will maintain their respective 25 percent and 15 percent weights, respectively.
  
  
• The MIPS #44 measure (Coronary Artery Bypass Graft (CABG) – Preoperative Beta-Blocker in Patients with Isolated CABG Surgery) will be retired from the MIPS program.
  
  
• The PSH Care Coordination improvement activity is now a "High" weighted improvement activity. The ASA asserts that this designation will reduce group burden on reporting improvement activities by half.

Interestingly, CMS did not finalize its proposal to increase the completeness threshold to 80 percent in the MIPS Quality performance category in 2023 as previously proposed. Instead, CMS will maintain a completeness of 70 percent for the next two years.

We will provide further details arising from the 2,414-page rule in a future alert. Until then, you can reach out to your account executive or contact us at info@anesthesiallc.com.

With best wishes,