Physician Fee Schedule on Emergency Medicine Groups
What Do You Need to Know About Emergency Physician Group Medicare Physician Fee Schedule?
The 2023 physician fee schedule will bring significant changes to the emergency physician group. CMS has updated the Medicare physician fee schedule (MPFS) to affect Part B payments for an emergency physician group,diagnostictests,andotheroutpatientservices.TheupdatebringsnewreimbursementrulestotheCMS quality payment program and a reduction in the Medicare conversion factor. The conversion factor has been reducedto$33.0607,a4.48%decreasefromthepreviousyear.Thespendingpackageincludesa2.5%reliefin 2023and1.25%in2024.
The 2023 Medicare physician fee schedule includes several new coding policies aimed at simplifying documentation requirements and updating payment guidelines for Evaluation & Management (E/M) services. CMShasadoptedthesameguidelinesestablishedbycommercialpayersintherecentCPTrevisionstotheE/M codesets.TheMedicarephysicianfeescheduleupdateshiftstheemphasistoMedicalDecisionMaking(MDM) for determining the acuity level of a patient visit, instead of requiring a specific number of elements in the HistoryofPresentIllnessandExamsectionsofthepatientrecord.Additionally,CMShasconfirmedthecurrent RVUsof2.74foremergencydepartmentLevel4visits,insteadofreducingitto2.60.
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ThebiggestchallengeposedbythenewcodingguidelinesisrelatedtoservicescurrentlybilledwithCPTcode99285forhighacuitypatientswhoarenothospitalizedcommonlyreferredtoas"treat-and-release."Generaldocumentationguidelineswill typicallysupportbillingwitha99285forpatientswhoareadmittedtothehospital.However,emergencymedicinephysicians willneedtobemoreexplicitindocumentingtheirMedicalDecisionMaking(MDM)whenthepatientisdischarged.
Inpatient/Observation Rule For Emergency Physician Group:
The8to24-HourInpatient/ObservationRulestatesthatapatientmustundergoobservationcareforaminimumof8hoursto beeligibleforsame-dayobservationcodesaspertheMedicarephysicianfeeschedule.IfaMedicarepatient'sobservationstay isshorterthan8hours,providersmustusetheinpatientcodes99221-99223instead.
TheCMShaspostponeditsproposaltoonlyconsiderthetimecomponentwhendefiningtheterm"substantiveportion"usedto determinethebillingpractitionerforasplitorsharedvisitintheMedicarephysicianfeeschedule.Thenewdefinitionwassetto take effect on January 1, 2023, however, numerous organizations argued that it contradicts the fundamental idea of collaborativecarebycreatingcompetitionbetweenphysiciansandadvancedpractitioners.Asaresult,thenewdefinitionhas beendelayeduntilJanuary1,2024,oruntiltheCMSreleasesfurtherguidance.
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Inpatient/Observation
Rule For Emergency Physician Group:
ThefinalruleincludesmodificationstotheMIPSqualitypayment program, which determines the Medicare payment adjustments for an emergency physician group that deliver services under MedicarePartB,includingemergencyandoutpatientservices.In 2023, clinicians can gain (or lose) up to 9% of their annual MedicarerevenuebasedontheirMIPSscore.Theeligibilitycriteria for those who have traditionally met the quality reporting requirement through their participation in an accountable care organization(ACO).
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