On July 13, the Centers for Medicare & Medicaid Services (CMS) released the CY2024 Medicare Physician Fee Schedule (PFS) Notice of Proposed Rulemaking (NPRM). This annual rule outlines policies related to provider reimbursement, coverage of telehealth services, review of specific codes, refinement of evaluation and management codes and updates to the Quality Payment Program. The ACR will submit formal comments before the Sept. 11 deadline. The final rule is expected in November 2023.
In the ACR’s initial reaction to the rule, ACR President Douglas White, MD, PhD, stated: “While the ACR appreciates CMS’ continued recognition of the value of complex care provided by rheumatologists and other cognitive care specialists by continuing to operationalize the evaluation and management (E/M) coding changes, we are gravely concerned that the proposed rule’s physician payment cuts contained in CMS’ conversion factor would add to physicians’ uncertainty about their continued ability to provide the highest quality of care to Medicare patients. The ACR will review the rule closely and looks forward to working with the CMS and Congress to mitigate the fee schedule’s impact on physicians who continue to confront workforce shortages, onerous payer utilization management policies, and sustained payment cuts.”
Payment Rate
The conversion factor is a key factor in determining reimbursement. The CMS proposes to decrease the conversion factor from $33.8872 to $32.7476, a 3.34% decrease from 2023. The decrease reflects the decrease of 2.15% neutrality adjustment required by statute and the 1.25% increase provided by the Consolidated Appropriations Act.
E/M Code Refinements
Complex Code: The rule proposes implementing a new code (G2211) to capture primary care or longitudinal patients with single, serious or complex conditions. The code will apply to outpatient visits as an additional payment.
Split/Shared Visit: In the CY2023 proposed rule, the CMS proposed that split/shared visits require the practitioner who provides a “substantial portion” of the visit to be the billing provider. A substantial portion of the visit is defined as time only and does not account for medical decision making. The CMS delayed this proposed policy in last year’s PFS. In the CY24 PFS NPRM, the CMS proposes to delay the implementation again until Dec. 31, 2024. For CY24, split/shared visits will be established by one of three components—history, time or medical decision making—to determine the billing provider.
Telehealth
The CMS proposes implementing several telehealth flexibilities that originated during the public health emergency. These proposals align with the statutes in the Consolidated Appropriations Act that allow for the expansion of telehealth services, including reimbursing telehealth visits at the non-facility rate, allowing the continuation of site-of-service flexibilities that allow patients to receive care in their homes and expanding the definition of telehealth practitioners to include physical therapists and occupational therapists. The proposed rule also continues to allow direct supervision for the immediate availability of the supervising practitioners through real-time audio-visual means through Dec. 31, 2024.
The ACR understands that there are continued questions regarding licensure across state lines. The regulations regarding these provisions are state based. The ACR is working on resources that will be available soon.
ACR Advocacy
The ACR team will be analyzing the proposed rule in greater detail and will provide more information on the rule and ACR’s response. The ACR is also working with the American Medical Association and other societies in urging Congress to pass the Strengthening Medicare for Patients and Providers Act (H.R. 2474), a bipartisan bill intended to update Medicare physician payments to reflect the impact of the broader economy on physician practices.
