Author: Tony Mira
The year-end coding and compliance rule changes have been finalized and widely addressed, but there are always a few smaller actions by federal officials that don’t get as much attention. In this alert, we take a look at some recent rules and announcements that may affect anesthesia and pain practices.
What a spread. Holiday dishes taking up three counters were a wonder to behold. Gazing inevitably led to grazing—a little of this and some of that. It didn’t take long before the plate was full. From Thanksgiving to New Years, most Americans were treated to a tasty assortment of satisfying cuisine and rich desserts. As we look to the beginning of another year, the government has set the table with a buffet of recently passed provisions that touch on a wide array of issues critical, or at least applicable, to most medical groups.
We’ve already provided you multiple alerts arising from the Medicare Physician Fee Schedule (PFS) Final Rule for 2023. However, there have been federal laws and regulations that have passed since the publication of the Final Rule that are also important to note. Certain deadlines are also coming up. With that in mind, let’s take a look at some of these recent provisions that may impact our readers.
The No Surprises Act (NSA) which seeks to eliminate surprise medical bills from providers who do not participate in the patient’s health plan, establishes a mechanism for working out disagreements between these non-participating providers and the insurance company—specifically where the disagreement is over the appropriate reimbursement for a medical service that had been rendered to a beneficiary. This mechanism involves an independent dispute resolution (IDR) process, wherein a government-approved IDR mediator will be sought by one of the disagreeing parties to intercede in the matter and make a determination of the appropriate payment. Of course, it costs the disputing parties to enter into the IDR process, and it’s the cost that has recently changed. Here’s the January announcement by the applicable federal departments:
The U.S. Departments of Health and Human Services (HHS), Labor, and Treasury (collectively, the Departments) are amending the prior 2023 guidance to increase the administrative fee for the Federal independent dispute resolution (IDR) process from $50 to $350 per party for disputes initiated during the calendar year beginning January 1, 2023, due to supplemental data analysis and increasing expenditures in carrying out the Federal IDR process since the development of the prior 2023 guidance.
So, not only are we seeing higher prices for gas and groceries, the inflation bug has also hit the IDR process—and at a whopping seven-fold rate increase! It remains to be seen the extent to which this increased cost will dampen the demand for IDR services among provider groups.
Last Minute Save?
In the closing days of December, Congress passed a massive spending bill that made multiple revisions to previous federal health provisions. The $1.7 trillion omnibus spending package included a moderation in Medicare provider pay cuts that had been previously mandated by the 2023 Medicare PFS Final Rule. The massive bill was signed by the president on December 29, making it the law of the land.
The estimated updated anesthesia conversion factor (CF) for 2023 is now set at $21.1249, reflecting a 2.03 percent cut from the 2022 anesthesia CF of $21.5623 but less than the 4.42 percent cut announced in the 2023 PFS Final Rule released back in November. The RBRVS (non-anesthesia) CF will be approximately $33.8872, which represents a 2.08 percent cut from the 2022 CF of $34.6062.
The omnibus package delays implementation of a Medicare PAYGO physician pay cut of four percent for two years, beginning in January 2023. The cuts will resume in 2025, pending further congressional action.
While this last-minute intervention by Congress saved providers from deeper cuts that had been previously announced, they did not eliminate Medicare pay cuts altogether. This was on the mind of American Society of Anesthesiologists (ASA) President Michael W. Champeau, MD, FASA, who released the following statement upon the passage of the omnibus bill:
We are extremely disappointed with this outcome. The entire Medicare payment system that is supposed to ensure appropriate payments for the essential services provided by our members is fundamentally broken; it just doesn’t work.
The ASA press release turned even more dour, if not dire, with the following characterization of the current state of the anesthesia specialty:
The combination of these Medicare cuts and the badly flawed implementation of the No Surprises Act is creating a perfect storm threatening anesthesiologists’ practices across the country. ASA is exploring legal, regulatory and legislative options for 2023 to address this threat.
Provider Relief Funds
Those providers who took advantage of the federal government’s Provider Relief Fund are reminded that the “Period 4” reporting window for such funds received between July 1, 2021 and December 31,2021 is now open. It will remain available for reporting until March 31, when the reporting window for that period will close.
Ancillary Medicare Guidance
Our team undertook a review of the latest updates to two of the primary Medicare source documents that deal directly with anesthesia issues: the Medicare Claims Processing Manual (MCPM) and the National Correct Coding Initiative (NCCI). In checking Chapter 12, Sections 50 and 140 (the sections dealing with anesthesiologists and anesthetists) of the MCPM, there were no updates found. The introductory paragraphs to the Anesthesia section of the NCCI also contained no material changes for 2023.
New ASC Procedures
There are 26 new procedures that are separately payable in the surgery center (ASC) setting, effective January 1, 2023. These include several pulmonary artery and anterior abdominal hernia procedures, as well as procedures dealing with the skull and heart, among others. These newly added procedures, along with their CPT codes and full descriptors, are found in Table 3 of the following link: https://www.cms.gov/files/document/r11762cp.pdf#page=15
The omnibus bill also addressed telehealth waivers. Specifically, telehealth flexibilities allowed under the COVID-19 public health emergency (PHE) will be extended to December 31, 2024. This acts to update previously passed legislation that retained these flexibilities for 151 days following the end of the PHE declaration.
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