Introduction

CMS (Center of Medicare and Medicaid Service) has released CY-24 (Calendar Year-2024) under Medicare Physician Fee Schedule Proposed (MPFS), which includes proposals about Quality payment programs and Medicare physician Payments. The new rule included the equity focus payment proposals and coding against the services that help to rehabilitate underserved communities. The proposal included separate coding and caregiver training programs for community health services. Coding, community integration services, payments for principal illness navigation services, and social health risk determinants are also included in the proposed rule. The article will analyze the rule from different facets to extract the true aim of the new proposal rule.

CY 24 Medicare Physician Fee Proposal Overview

Medicare Physician Fee Schedule has been active since 1992, and all billing professionals make their Medicare Payments under the rule. Physician services paid under the PSF are provided in the office, clinical setting, and laboratory, and service expenses and malpractice expenses are counted as eligible for payment from the insurance company. The proposed rule addresses the Medicare quality provision and physician payment from Jan 1, 2024. Under the new rule, in all CMS projects conversion factor will decrease to 3.36%. Cardiovascular reimbursement will remain flat despite changes in regulations and policies. There are 0% updates made for the physician, which is unmatched by the rising inflation rate and could lead the physicians toward financial instability in the Medicare payment system. It could discourage physicians from willingly and actively participating in the Medicaid and Medicare healthcare service program. AMA and other medical societies set guidelines on physician payment reforms.

CY-24 Proposal rule major points regarding Medicare Physician Fee Schedule

Following are the significant points of the CY 24 proposal rule regarding Medicare Physician Fee Schedule are

• A new coding system will be used for underserved communities. It includes caregiver training, principle navigation services, community health integration, and investigation of social determinants for assessing health risk.
• Payments are made for the physician separately for the dental services offered during the cancer treatments.
• According to the new rule, married health counselors, mental health specialists, and family therapists can enroll in the Medicare program and bill against the services provided to patients.
• CMS also proposed whole-person care under the Medicare shared savings program.
• After implementing CY 24 Medicare Physician Fee Schedule, payment rates for patient evaluation and management visits will be based on the time spent by the billing practitioner.
• It is proposed to make reimbursement on the non-facility rate for certain telehealth services.
• Continue supervision of practitioners in the real-time video and audio telecommunication interaction will be performed by the federally qualified health centers.
• The rule will also add new pathways to women’s health treatment, prevention, quality and digestive health, and musculoskeletal care.

Changes in home health payments

In short, the proposed rule will decrease home health payments by up to 2.2% for the CY 24. The significant decrease in the estimated payments for CY 24 turns out in the form of an increase of 2.7% in home health payments and a 0.2% increase in payments due to a low FDL ratio.

Extension in advanced telehealth policies

Originate sites where beneficiaries receive telehealth services from home and practitioners receive payments at high non-facility Medicare Physician Fee Schedule rates in CY 24. Now therapists allow enrolling in the telehealth program. Allowing payments and coverage will be furnished through audio-only technology. CMS also proposed the direct supervision of patients through audio/video. CMS also will enable physicians to oversee services using audio/video training at their residency location.

Quality Payment program updates

The national quality focus on initiatives patronizing health equity and healthcare quality. CMS also invites comments regarding improving beneficiaries’ healthcare through implementing learning from the CMS innovation model. CMS also seeks advice about cost measures and policy modifications to foster continuous clinical-based improvements.

Payment for services

For 20224, CMS proposed adding episode-based cost measures for emergency medicine, psychoses conditions, depression, lower back pain, and health failure and removing episode-based measures for pneumonia with hospitalization. CMS also codifies the dental services payment policies during neck and head cancer treatment. CMS also proposed payment for specific dental services covered under the cancer treatment and supported the dental services as an integral part of the clinical success of covered medical services.

Conclusion

The proposal rule is about routine updates for the payment rates of Medicare home health services for CY 24. The rule is accurately compline with the regulatory and statutory requirements. The rule provides information on health trends, solicits comments regarding home health services and implements changes to the rates of home health payments, codifies statutory requirements, and revises labour-related market share. The new rule also proposed changes to the reporting program of home health and home health purchasing and made coding changes per changes in the healthcare legislation. The Medicare Physician Fee Schedule rule also proposed revising supplier enrolment and Medicare provider requirements. The proposed rule is a serval other proposals whose aim is to broaden the administrative-wide strategy to create an equitable healthcare system. That contributes to better access to access to healthcare, health quality, affordability, and health innovation.

FAQs

What is Medicare Physician Fee Schedule (MPFS)?

It is the breakdown of reimbursement prices that an insurance company proposes to pay against a physician’s service to their patients. In simple words, Medicare Physician Fee Schedule is the contracted rate. Medicare Physician Fee Schedule is often a part of the insurance company contract, but sometimes it could be a separate document.

How can I find RVU (Relative Value Unit)?

Historical conversion factors are listed on the AMA (American Medical Association) starting in 1992-2023. The cost of each RVU is listed as a conversion factor on AMA. For example, if the cost of RVU in 2023 is $33.8872, then the conversion factor will be $33.8872.

What are limited charges, and how can you calculate limited charges?

It is the amount that exceeds the Medicare-approved charges. In addition to it, the demand for the charges is made from the non-participating healthcare providers. Limited charges are 115% of the non participative fee schedule amount, and it is extreme the non-applicant may charge the recipient on the unassigned claim.

What are caregiver training services in CY 24?

After implementing CY-24 under the Medicare programs, a trained practitioner is involved in the caregiver plan to support the patient in fighting certain diseases. Then all these services will be eligible for payment when furnished by a physician, non-physician, or therapist. If a person is finalized under high-quality or supportive caregivers based on their work, they will enroll in the advanced caregiver training program.

Is there any proposal in CY 24 regarding telehealth extension?

Yes, the rule proposed the provisional extension of telehealth services. According to the proposed rule, geographic restrictions will be no more applicable. It is also proposed to extend the list of practitioners for the telehealth program, which includes speech-language therapists, occupational therapists, counselors, and marriage family therapists. Until the end of 2025, even mental health services could be covered under telehealth health services.

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