Home » Regulation and Payment Adjustments Coming in 2022 from CMS

Regulation and Payment Adjustments Coming in 2022 from CMS

by Nathan Zachary
MIPS 2022

When you use the appropriate data analysis services, you may be prepared.
The Centers for Medicare and Medicaid Services (CMS) published its final rule for 2022 on November 2, 2021, with the intention of implementing new policy and payment modifications on January 1, 2022. The primary objective that is being promoted by CMS is the development of a health care system that will lead to improvements in terms of innovation, affordability, accessibility, and quality. The following is a list of some of the changes that will have the most significant effect. You may read the complete version of the new rule here.

Reductions in the Fee Schedule for Medical Professionals (PFS)

The PFS assigns relative value units, or RVUs, as payment rates for many different kinds of physician services. These RVUs are determined by the PFS and are based on the resources that are generally utilized to perform the service. Rates are calculated for the entire market by employing the dollar conversion factor that is set and described in the PFS for the year 2022. In 2021, the PFS was provisionally increased by 3.75% in order to provide some level of relief from COVID-19. That raise is about to run out, and it will not be renewed in the future. In practice, as a result of the PFS conversion factor change, the payment amount will be reduced from $34.89 per RVU in 2021 to $33.59 in 2022.

MIPS Categories

The MIPS quality, cost, encouraging interoperability, and enhancement efforts categories will all be undergoing revisions as a result of the recent announcements. QPP MIPS 2022 Reporting minimal performance criteria have increased from 60 points in 2021 to 75 points in 2022. The previous level was set at 60 points. After a number of rough years, this can prove to be a challenge for a lot of different physician offices.

Visits to the ER Can Be Shared or Split

The Centers for Medicare and Medicaid Services (CMS) has made a number of announcements about E/M code sets. These announcements represent modifications that will be made in 2021 to the AMA CPT Codebook.

The practitioner who is responsible for the substantial component of the visit, which is considered to be more than fifty percent of the total time spent, is the one who will be responsible for billing for the full visit. The documentation must accurately reflect the collaborative character of the visit and bear the signature of the healthcare professional who was responsible for the substantive aspects of the visit. This may have a particularly significant impact on the arrangements and payments made to physicians and mid-level providers. These codes will soon have a unique modifier applied to them in order to facilitate data gathering and evaluation of the program.

The Services of Critical Care

By the year 2022, trips to critical care facilities will be able to be paid for on the same day as other emergency and primary care visits, either by the same provider or by another clinician working for the same group and having the same specialization. The visit to critical care must be a new development and must be unrelated to the initial admission to the emergency room. Another modifier will be added to these codes so that they can be tracked more accurately.

Reactivation of Telehealth Services

In the year 2020, as the pandemic progressed, a significant number of telehealth services were provisionally included on the list of CMS-paid services in order to offer essential care. The contract for these services has been extended until the 31st of December in 2023, giving CMS further time to determine whether or not they should be added permanently.

Confronting and Overcoming Obstacles

It’s possible that when the ancient Greek philosopher Heraclitus declared, “The only constant in life changes,” he was referring to the ever-evolving field of medicine. In addition, each of these modifications to CMS highlights the significance of utilizing performance analytics in emergency medicine.

Many health care organizations have tightened their financial belts to the very last notch over the course of the previous two years, and they now need to discover new opportunities and efficiency in order to remain operational. d2i is able to deliver customized strategies based on particular data patterns, which in turn enables specific action plans for success in the environment of 2022.

For HCOs to be able to formulate appropriate action plans in response to newly implemented rules, a robust data strategy is required. Get in touch with d2i to learn more about how analytics may assist maximize appropriate reimbursement as well as MIPS incentives while also enhancing efficiency and patient safety.

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