Healthcare providers, including doctors and therapists who treat nursing home patients, will see a key payment factor cut by 4.4% next year.
The Centers for Medicare & Medicaid Services announced the change to the Medicare Physician Pay Schedule conversion factor in a broader physician payment rule published late Tuesday. The conversion factor is part of a CMS formula used to reimburse for Part B care including physician and nurse practitioner services, rehab therapy, lab work and X-rays for Medicare patients in nursing facilities.
Last year, CMS proposed a 3% conversion factor cut, but Congress passed supplemental funding to offset it. It’s a strategy more than 100 healthcare groups are hoping they can win legislative backing for again this year, but the path forward isn’t as clear as in years past.
“Congress has stepped in for the last two years to mitigate the cut and we are lobbying for them to do it again this year,” Advion Executive Vice President Cynthia Morton told McKnight’s Long-Term Care News Tuesday night. “Congress is becoming fatigued with restoring this cut, and so we are concerned that Congress won’t mitigate the entire 4.4% cut that CMS has now finalized.”
That, combined with sequestration cuts triggered by a federal budget-neutrality law, could drive providers out of practice, other medical groups cautioned.
“The rate cuts would create immediate financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians,” The American Medical Association said, calling the rule an “ominous reality unless lawmakers act before Jan. 1.”
In total, physicians could see Medicare payments cut by nearly 8.5% next year, if so-called PAYGO cuts also are factored in.
Morton expressed relief that the broader rule put off plans to reduce payment for codes related to remote therapeutic monitoring.
“CMS had created these codes to move into digital health. Strangely, then they proposed to significantly reduce the value of the codes,” Morton said. “However, in response to concerns raised by Advion and other stakeholders, CMS is NOT finalizing its proposal to create 4 new G-codes (GRTM-1-4).”
Instead of reducing value based on who provides the service, CMS is finalizing the changes to allow any RTM service to be furnished under general supervision.
CMS is also making significant changes to reimbursement for specimen collection and travel allowance payments for clinical labs serving nursing facilities and the home care patients, Morton noted. In 2023, CMS will increase the specimen collection fee from $3 to $10.57 for a specimen collected from a SNF patient or on behalf of a home health agency. CMS is also proposing to adjust the rate for inflation in 2024.