Updates to Physician Self-Referral RegulationsĬMS is proposing to revise the regulation to include as a potential indirect compensation arrangement any unbroken chain of financial relationships in which the compensation arrangement closest to the physician (or immediate family member of the physician) involves compensation for anything other than services that he or she personally performs. CMS proposes that those visits could be furnished and billed as split (or shared) visits. However, for other visits to which the regulation at § 483.30 does not apply, there is no requirement for a physician to directly and solely perform the visit. If finalized, their split visit proposal would not apply to the SNF/NF visits that are required to be performed in their entirety by a physician any SNF/NF visit that is required to be performed in its entirety by a physician cannot and would not be able to be billed as a split (or shared) visit. That regulation requires that certain SNF/NF visits must be furnished directly and solely by a physician. CMS is proposing these modifications to the current policy and conditions of payment for split (or shared) visits to account for changes that have occurred in medical practice patterns, including the evolving role of NPPs as part of the medical team.ĬMS did note that under its current policy, no E/M services can be furnished and billed as split (or shared) visits in the SNF setting per the Conditions of Participation in 42 CFR 483.30 regarding the SNF/NF visits that are required to be performed in their entirety by a physician. CMS will facilitate the submission of requests to add nursing facility services to the permanent list of telehealth services in the CY 2023 PFS for consideration in the CY 2024 PFS rule.ĬMS is proposing to modify its policy to allow physicians and NPPs to bill for split (or shared) visits for both new and established patients, and for critical care and certain Skilled Nursing Facility/Nursing Facility (SNF/NF) E/M visits. However, once the PHE ends, the practitioner will again be restricted to billing the 99307-99310 codes to once per 14 days as was finalized in the CY2021 physician fee schedule.ĬMS would like more time to collect more information regarding utilization of these services during the pandemic and provide stakeholders the opportunity to continue to develop support for the permanent addition of appropriate services to the telehealth list through CMS’ regular consideration process, which includes notice-and-comment rulemaking. Nursing facility subsequent care codes (99307-99310)-Permanently on list of Medicare telehealth services, During the PHE, the telehealth frequency limitation has been eliminated for these codes.Once the PHE ends, they will NOT be extended. Domiciliary or rest home (99324-28)-Temporarily on list of Medicare telehealth services list through the end of the PHE.Once PHE ends, they will NOT be extended. Nursing facility services initial visit codes (99304-06)-Remain temporarily on list of Medicare telehealth services list through the end of the Public Health Emergency (PHE).Nursing Facility Codes 2022 Proposed Rates The table below highlights the RVUs and percentage of change for the codes. The PFS conversion factor reflects the statutory update of 0.00% and the adjustment necessary to account for changes in relative value units and expenditures that would result from our proposed policies. With the proposed budget neutrality adjustment to account for changes in RVUs (required by law), and expiration of the 3.75% payment increase provided for CY 2021 by the Consolidated Appropriations Act, 2021 (CAA), the proposed CY 2022 PFS conversion factor is $33.58, a decrease of $1.31 from the CY 2021 PFS conversion factor of $34.89. The rates for nursing home services (99304-99318) will see between a 3-5% decrease. Last week, the Centers for Medicare & Medicaid Services (CMS) released the CY 2022 Medicare Physician Fee Schedule Proposed Rule.
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