Medicare Reimbursement Updates: What You Need to Know
As a healthcare provider, staying up-to-date on Medicare reimbursement updates is crucial to ensure you receive fair compensation for your services. In this article, we’ll explore five recent updates on Medicare reimbursement that you need to know.
Update 1: Medicare Physician Fee Schedule (MPFS) Final Rule for 2023
The Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2023 Medicare Physician Fee Schedule (MPFS) in November 2022. The rule includes several updates, such as:
- Changes to the Medicare conversion factor: The conversion factor will be reduced by $0.55, resulting in a national average fee schedule increase of 3.36%.
- New payment rates for services: The final rule includes new payment rates for various services, including those related to anesthesia, radiology, and pathology.
- Expansion of telehealth services: CMS has expanded the list of telehealth services that can be furnished via audio-only technology, including services related to mental health and substance abuse treatment.
📝 Note: The MPFS final rule for 2023 includes several other updates and clarifications, so be sure to review the official CMS website for more information.
Update 2: Medicare Advantage (MA) Risk Adjustment Model Changes
In January 2023, CMS announced changes to the Medicare Advantage (MA) risk adjustment model. The updated model aims to improve payment accuracy and fairness by:
- Incorporating new diagnoses: The updated model includes new diagnoses and excludes certain codes to better reflect patient complexity.
- Weighting factors: CMS has adjusted the weighting factors for various conditions to more accurately reflect their impact on patient outcomes.
- Dual-eligible beneficiaries: The updated model includes special provisions for dual-eligible beneficiaries to account for their unique needs.
Update 3: Medicare Outpatient Prospective Payment System (OPPS) Rule for 2023
CMS released the final rule for the 2023 Medicare Outpatient Prospective Payment System (OPPS) in November 2022. Key updates include:
- Changes to the OPPS payment rates: The final rule includes updates to the OPPS payment rates, including a 3.8% increase for hospital outpatient departments.
- Expansion of services under the 340B program: The final rule expands the list of services eligible for reimbursement under the 340B program, which provides discounted outpatient medications to eligible hospitals.
- Quality reporting requirements: CMS has updated the quality reporting requirements for the Hospital Outpatient Quality Reporting (OQR) program.
📊 Note: The OPPS final rule for 2023 includes several other updates, including changes to the Medicare Part B inpatient outlier pooling threshold.
Update 4: Medicare Shared Savings Program (MSSP) Changes
In January 2023, CMS announced changes to the Medicare Shared Savings Program (MSSP). Key updates include:
- New tracks for Accountable Care Organizations (ACOs): CMS has introduced new tracks for ACOs, including a new “Enhanced Track” that provides more flexibility and incentives for ACOs.
- Changes to the repayment mechanism: CMS has updated the repayment mechanism for ACOs, allowing for more flexibility in managing shared savings.
- Increased focus on health equity: CMS has emphasized the importance of health equity in the MSSP, encouraging ACOs to prioritize addressing disparities in care.
Update 5: Medicare Home Health Value-Based Purchasing (HHVBP) Model Expansion
CMS has announced the expansion of the Medicare Home Health Value-Based Purchasing (HHVBP) model to include all 50 states and the District of Columbia. The HHVBP model aims to improve quality and reduce costs in home health care by:
- Incentivizing high-quality care: The model provides incentives for home health agencies (HHAs) to deliver high-quality care and improve patient outcomes.
- Reducing avoidable hospitalizations: The model encourages HHAs to reduce avoidable hospitalizations and improve care coordination.
- Focusing on patient-centered care: The model prioritizes patient-centered care, emphasizing the importance of individualized care plans and patient engagement.
By staying informed about these updates, healthcare providers can navigate the complex Medicare reimbursement landscape with confidence.
Key Takeaways
- The Medicare Physician Fee Schedule (MPFS) final rule for 2023 includes updates to the conversion factor, payment rates, and telehealth services.
- The Medicare Advantage (MA) risk adjustment model changes aim to improve payment accuracy and fairness.
- The Medicare Outpatient Prospective Payment System (OPPS) rule for 2023 updates payment rates, expands services under the 340B program, and revises quality reporting requirements.
- The Medicare Shared Savings Program (MSSP) changes introduce new tracks for Accountable Care Organizations (ACOs) and update the repayment mechanism.
- The Medicare Home Health Value-Based Purchasing (HHVBP) model expansion aims to improve quality and reduce costs in home health care.
What is the Medicare Physician Fee Schedule (MPFS)?
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The Medicare Physician Fee Schedule (MPFS) is a payment system used by Medicare to reimburse physicians and other healthcare providers for services rendered to Medicare beneficiaries.
How does the Medicare Advantage (MA) risk adjustment model work?
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The Medicare Advantage (MA) risk adjustment model is a payment system used by Medicare to adjust payments to MA plans based on the health status and risk profile of their enrolled beneficiaries.
What is the Medicare Shared Savings Program (MSSP)?
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The Medicare Shared Savings Program (MSSP) is a program that encourages Accountable Care Organizations (ACOs) to improve quality and reduce costs in care delivery, with the potential to share savings with Medicare.
