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New Year, New Rules Pt.1: Medicare Changes For 2022

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Soriah Esquivel

In June of 2021, Centers for Medicare & Medicaid Services (CMS) proposed a new physician payment rule that focuses on improving healthcare equity and increasing patient accessibility. With this rule being finalized in November of last year, its changes are now in effect and will influence not only how your practice operates but also how your patients receive care.

In our three part #rtblogseries, learn some key specifics about CMS’s goals with this new Physician Fee Schedule (PFS) rule and get the resources you need to help prepare your practice as well as proactively care for your patients!

Medicare Rule Changes Acronyms

Behind The Decision

CMS administrator, Chiquita Brooks-LaSure quoted disparities within the U.S. healthcare system which prompted a need for change “...while at the same time demonstrating the positive impact of innovative policies to reduce these disparities”. She went on to explain how CMS aims to learn from these issues and work to do better: “CMS aims to take the lessons learned during this time and move forward toward a system where no patient is left out and everyone has access to comprehensive quality health services.”

Conversion Factor

The PFS rule has notably changed the conversion factor (used to determine provider reimbursements) to $33.59, a $1.30 decrease from 2021. Additional changes under the PFS rule include alterations to the Open Payments Program as well as updated policies that impact telehealth, evaluation and management codes. These amendments are designed to support data usability and integrity for public research as well as clarify unique billing scenarios.

CMS To Expand Telehealth For Behavioral Care

The finalized rule also implements legislation that removes statutory restrictions on telehealth and enables patients easier access to services they may need to receive diagnoses, evaluation or treatment. These changes are designed to expand coverage for patients located in underdeveloped areas by allowing Medicare to pay for mental health visits when they are provided by Rural Health Clinics and Federally Qualified Centers.

Additionally, CMS has amended the definition of interactive telecommunications for telehealth services. Now, under certain conditions, these changes allow payment to eligible providers and their patients over home-based audio-only telephone calls. This amendment specifically caters to those living in communities with poor broadband infrastructure or for Medicare recipients who do not have access to audio/video capabilities.

As a result of COVID, another note-worthy change is that certain services that were added temporarily to Medicare’s telehealth list (that would have otherwise been removed at the end of 2021) have been extended through the end of 2023.

Proposed Quality Payment Program Advancement

CMS originally proposed requiring clinicians "to meet a higher performance threshold in order to be eligible for incentives,” which included not only healthcare providers, but social workers and nurses or midwives. This update would have adjusted the quality of care threshold to align with the criteria outlined in the Quality Payment Program’s (QPP) Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act of 2015. With the intention of raising the standard of care for Medicare recipients, these proposed changes have unfortunately been delayed until 2024.

Please keep in mind that these are just a few adjustments brought on by this new rule. Other changes affecting coinsurance, vaccine requirements, diabetes prevention and health equity data collection can be found on CMS's website. It is also important to note that there are a myriad of changes being made to specific payment processes that may affect you and your practice.

Be on the lookout for part two of our “New Year, New Rules” #rtblogseries! Next, we will go over clinical units and changes made to the Medicare payment process. In the meantime, check out these fact sheets provided by CMS for further details.

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