CMS has released its calendar year 2022 Medicare Physician Fee Schedule, and Medicare Advantage plans should be aware of its key provisions, including language lowering the conversion factor for next year to $33.59, a decrease of $1.30 from the CY 2021 conversion factor.1
The final rule also promotes use of telehealth and other technologies for behavioral health care, aims to expand the diabetes prevention program and increases vaccine administration payment rates.2,3 For example, the agency will allow patients in-home access to telehealth services for the diagnosis, evaluation and treatment of mental health disorders. Medicare will also cover mental health visits provided using telecommunications technology, including phone calls, by Rural Health Clinics and Federally Qualified Health Centers.
CMS is working to expand its Medicare Diabetes Prevention Program by waiving the Medicare enrollment fee for any organization that applies to enroll as an MDPP supplier on or after Jan. 1, 2022. This is expected to increase access to MDPP services for Medicare beneficiaries in rural areas and lower the rate of diabetes in both urban and rural communities.
The rule maintains the current payment rate of $40 per dose COVID-19 vaccines through the end of the final calendar year of the ongoing public health emergency. After that, the payment rate will align with other Part B preventive vaccines. Meanwhile, the final rule increases payment rates for administration of influenza, pneumococcal and hepatitis B vaccines, from about $17 to $30 in the hopes of increasing access.
In keeping with statutory requirements for the CMS Quality Payment Program’s Merit-based Incentive Payment System, the agency has set a higher performance threshold that clinicians must exceed in 2022 to meet eligibility for positive payment incentives. It also announced the first seven MIPS Value Pathways, which clinicians can report on to meet MIPS requirements.
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- LaPointe, J. CMS releases final rule for CY 2022 Medicare Physician Fee Schedule. RevCycleIntelligence. Nov. 3, 2021. https://revcycleintelligence.com/news/cms-releases-final-rule-for-cy-2022-medicare-physician-fee-schedule
- CMS physician payment rule promotes greater access to telehealth services, diabetes prevention programs. CMS Newsroom. Nov. 2, 2021. https://www.cms.gov/newsroom/press-releases/cms-physician-payment-rule-promotes-greater-access-telehealth-services-diabetes-prevention-programs
- CY 2022 payment policies under the physician fee schedule and other changes to Part B payment policies; Medicare Shared Savings Program requirements; provider enrollment regulation updates; and provider and supplier prepayment and post-payment medical review requirements. Federal Register. Nov. 19, 2021. https://public-inspection.federalregister.gov/2021-23972.pdf