Rachel Stauffer’s Post

The Centers for Medicare & Medicaid Services (CMS) recently released the Calendar Year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-1807-P] Proposed Rule, which includes proposals related to Medicare physician payment and the Quality Payment Program (QPP). Most significant to telehealth, CMS did not value the new evaluation and management (E/M) codes and continued to highlight the need for congressional action to extend the PHE Medicare flexibilities. The agency does add several codes to the provisional and permanent Medicare Telehealth Services List, but declined to move any codes already on the provisional list to the permanent list. CMS will be doing a comprehensive review of the provisional codes, although declined to provide any detail or timeline for this analysis. CMS also is proposing to broaden the definition of “interactive telecommunications” to include audio-only for any telehealth services. It is currently mental health only. However, even if they move forward with these policies, extending the Medicare telehealth flexibilities is essential to allow providers to bill for these services. The full text of the proposed rule is available here: https://lnkd.in/eGXgUWWc, and telehealth policies begin on page 14. Comments on the proposed rule are due on September 9, 2024. #telehealth #virtualcare #healthcarepolicy #CMS #PFS

🚨 Telehealth Updates Impacting Medicare Risk Adjustment (MRA) Programs 🚨 We’re excited to share key updates from the Centers for Medicare & Medicaid Services (CMS) that impact telehealth services and their role in Medicare Risk Adjustment (MRA) programs. 📅 CMS Finalizes 2025 Medicare Physician Payment Schedule The latest update includes important changes to telehealth policies that directly impact risk adjustment. Here's what you need to know: •Telehealth Flexibility Extension Congress has extended telehealth flexibilities, allowing Medicare patients to access telehealth services from any location—urban or rural—through March 31, 2025. •Secondwave’s Continued Commitment At Secondwave, we remain dedicated to ensuring compliance and continuity of care. We will continue coding diagnosis codes from telehealth services that meet the face-to-face requirements outlined by CMS, through the March 31, 2025 extension. This extension highlights the critical role telehealth plays in delivering accessible, high-quality care for Medicare Advantage beneficiaries. We’re here to support your efforts in maintaining accurate, compliant diagnoses within the Secondwave MRA program. If you have any questions or need assistance, feel free to reach out! Text - H.R.10545 - 118th Congress (2023-2024): American Relief Act, 2025 | Congress.gov | Library of Congress #Telehealth #MedicareRiskAdjustment #HealthcareCompliance #Telemedicine #MedicareAdvantage #CMS #HealthcareInnovation #Secondwave

🚨 **Key Updates from the CY 2024 Medicare Physician Fee Schedule Final Rule – What It Means for Healthcare Professionals** 🚨 The Centers for Medicare and Medicaid Services (CMS) recently released the **CY 2024 Medicare Physician Fee Schedule Final Rule**, introducing several major policy updates that will undoubtedly have ripple effects across our industry. As healthcare professionals, it's critical to stay informed about these changes and their broader implications. Here's a breakdown of what you need to know: --- ### 💰 **1. Reduction in the Conversion Factor** The final CY 2024 **Conversion Factor (CF)** is **$32.7442**, marking a **3.37% decrease** from last year’s $33.8872. A statutory **0% update** for 2024 combined with a **negative 2.18% budget neutrality adjustment** contributed to this reduction. Though the Consolidated Appropriations Act (CAA) of 2023 provided some protection, this reduction still poses significant challenges for practices, especially smaller or independent ones. **Implications:** This cut amplifies the growing financial strain on providers. In a landscape already grappling with workforce burnout and rising operational costs, how will practices balance financial sustainability while delivering patient-centric care? --- ### 📱 **2. Key Telehealth Policy Updates** CMS continues to recognize the importance of telehealth services, finalizing provisions to **expand payment for selected services** (e.g., administration of vaccines at home). **Implications:** Telehealth’s evolving reimbursement policies reflect its transition from a pandemic-era necessity to a long-term staple of modern care delivery. Providers must continue to adapt to leveraging virtual care for multiple demographic needs while keeping an eye on future reimbursement structures. --- ### ♻️ **3. Medicare Shared Savings Program (MSSP) Enhancements** The updates aim to expand coverage and payments for additional services under the MSSP, promoting improved care coordination and population health outcomes.

#TelehealthBilling# Medicare practitioners and patients can continue to perform/receive telehealth services as they have since the start of the pandemic for the next three months. These rules (CMS calls them flexibilities) were set to expire Dec. 31, 2024. The current Medicare telehealth rules were implemented on an emergency basis in March and April of 2020 during the pandemic. When the pandemic ended, CMS “extended” the rules but states they don’t have the authority to keep the current rules as they are without an ACT OF CONGRESS. The first keep-the-government-open bill from Dec. 20 extended Medicare telehealth for two years. It didn’t pass. The bill that passed and was signed into law extends telehealth for Medicare patients as we know it now until March 31, 2025. Then, Congress must ACT again or we have the return to the pre-pandemic rules. Does this mean we can use the new CPT telehealth codes 98000—98015? Not for Medicare patients. They have a status indicator of invalid. Continue to use office visit codes with POS 02 or POS 10. And other payers can make their own telehealth rules. Thanks to Nicoletti Betsy of CodingIntel, this may be a gray area of claim edit for payment integrity on telehealth especially, Medicaid and Commercial payers.

🚨 Key Updates from the CY 2025 Medicare Physician Fee Schedule Final Rule 🚨 The Centers for Medicare & Medicaid Services (CMS) has released the final rule for the Medicare Physician Fee Schedule (PFS) for 2025. This rule brings impactful changes that providers and healthcare professionals need to know to stay compliant and optimize care delivery. 🔑 Highlights of the Final Rule: ✅ Payment Adjustments: Updates to reimbursement rates under the PFS. ✅ Telehealth Continuation: Extended telehealth flexibilities for certain services and settings. ✅ Mental Health Services: Expanded access for behavioral health, including new coverage for services like substance use disorder treatment. ✅ Evaluation and Management (E/M) Codes: Further refinements to E/M visits to improve provider burden and patient outcomes. ✅ Chronic Care Management (CCM): New codes and improved payments for managing chronic conditions. 📌 Why It Matters for Providers: These updates reflect CMS’s continued focus on: -Expanding telehealth for accessibility. -Enhancing mental health support across Medicare services. -Streamlining E/M processes to allow providers to focus more on patient care. -Addressing healthcare equity and optimizing patient outcomes. As the healthcare landscape evolves, understanding these policy changes will be critical to: 🔹 Maximizing reimbursements 🔹 Reducing administrative burdens 🔹 Delivering patient-centered care 📄 For the official CMS document and full summary, check here: MM13887 - Medicare Physician Fee Schedule Final Rule Summary: CY 2025 ⚙️ Providers, how are you preparing for these updates? Share your insights below! 👇 #Medicare2025 #PhysicianFeeSchedule #HealthcareUpdates #Telehealth #MentalHealth #CMS

Without Congressional action to extend current Medicare telehealth flexibilities, the Centers for Medicare & Medicaid Services (CMS) may need to establish Medicare payment policies (including for telehealth) for calendar year (CY) 2025 under the assumption these flexibilities will not exist. This is evident in the Medicare Physician Fee Schedule proposed rule, which was released just over a month ago. This uncertainty around Medicare telehealth flexibilities is already creating issues for providers and patients. PAVC and other stakeholders recently sent a letter to House and Senate leadership, urging quick action on legislation to extend current Medicare telehealth flexibilities, in light of the fast-approaching year-end deadline. Read the full letter here: https://lnkd.in/eS4Qu6Mp #Telehealth #VirtualCare #Medicare #HealthPolicy

🚨 Attention Healthcare Professionals! 🚨 The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule for the 2025 Medicare Physician Fee Schedule (MPFS), and it includes a 2.93% average payment rate reduction for physicians. This marks the fifth consecutive year of reduced reimbursement, despite CMS's commitment to advancing health equity and supporting whole-person care. 🔍 Key Points to Consider: - 2.93% Payment Cut: A significant reduction impacting physicians nationwide. - Rising Costs: The Medicare Economic Index (MEI) is projected to increase by 3.6%, widening the gap between payment rates and practice costs. - Long-term Impact: Physicians have faced a 29% decline in Medicare payments since 2001, adjusted for inflation. The American Medical Association (AMA) warns that these repeated cuts threaten patient access to care. It's crucial to address this unsustainable trend to ensure that healthcare providers can continue delivering quality care to patients. 💡 What Can You Do? - Stay informed about these changes and their potential impact on your practice. - Engage with professional organizations and advocacy groups to voice your concerns. - Explore innovative solutions to optimize practice management and efficiency. Together, we can advocate for a more sustainable and equitable healthcare system. Let’s stay connected and support each other in navigating these challenging times. #MEDSCoders #Healthcare #Medicare #PhysicianFeeSchedule #CMS #HealthEquity #PatientCare #MedicalBilling #MedicalCoding #PracticeManagement #Advocacy

It continues to be encouraging to see the commitment that the Centers for Medicare & Medicaid Services has toward expanding and enriching pathways for more #Medicare patients to receive care in an accountable relationship. This Health Affairs Forefront article authored by CMMI and CMS leadership summarizes those efforts and highlights the proposed change in the 2025 Physician Fee Schedule introducing Advanced Primary Care Management billing codes to help support primary care practices that are delivering more robust care management and advanced primary care services to Medicare patients. As with RPM and CCM codes I expect that a small subset of practices will engage in these billing codes initially, but for those who are well setup to do so it provides a more sustainable funding mechanism to bring more dollars into Primary Care and help to create a hybrid financial model between FFS and Full Capitation. I’m curious what others think about these proposed codes https://lnkd.in/eurGqvPW

CMS Proposed Rule for CY 2025 Medicare Physician Fee Schedule - HIT Consultant Title: CMS Proposed Rule for CY 2025 Medicare Physician Fee Schedule #Overview The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule for the Calendar Year (CY) 2025 Medicare Physician Fee Schedule. The rule includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule. #Key Changes CMS is proposing changes to the payment rates for evaluation and management (E/M) services, telehealth services, and other codes. The proposed rule also includes updates to the Quality Payment Program and the Merit-based Incentive Payment System (MIPS). #Telehealth Services The proposed rule would make certain telehealth services permanent beyond the public health emergency. CMS is ai.mediformatica.com #medicare #physician #proposedrule #coding #acceibility #administration #affordability #better #healthcare #healthcaresystem #innovation #january #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/3YmLuaD)

#CMS sent out notification this morning "Find Out How CMS is Expanding Access to High Quality Accountable Care" I have spoken about this more than a couple times: Medicare ACO strategy. Per CMS email this morning "This Health Affairs Forefront blog describes how CMS aims to bring high-quality accountable care to all people with Medicare through these ACO initiatives and the Medicare Physician Fee Schedule." Do you know their strategy? "In 2021, the Centers for Medicare and Medicaid Services (CMS) set a goal to have 100 percent of beneficiaries with traditional Medicare in accountable care by 2030, where they have longitudinal care relationships with providers that are responsible for managing the quality and total cost of their care." "The two main pathways for delivering accountable care to traditional Medicare beneficiaries have been through CMS’s accountable care organization (ACO) initiatives and the CMS Center for Medicare and Medicaid Innovation’s (Innovation Center’s) advanced primary care model tests." It starts with a strong Primary Care Model yet 45% of providers do NOT belong to this model. More financial incentives are being initiated and tested so that, again, their goal of 100% traditional Medicare participation by 2030. If you do not know how each ACO determines payments, my suggestion is you read up on them because 2030 is not too far away! #frm #marketaccess #patientaccess #medicare #medicarepartb #medicareparta #medicalbillingandcoding #pharma #nationalaccounts #revenuecyclemanagement #beintheknow