The Centers for Medicare & Medicaid Services (CMS) recently unveiled several noteworthy updates set to take effect on January 1, 2023. These changes encompass reimbursement rates, the introduction of new CPT codes, program expansions, and the addition of a novel care management initiative.
Reimbursement Changes in 2023 In general, the CMS 2023 fee schedule resulted in an average reimbursement reduction of 2.08%. This dip is primarily due to a required budget neutrality adjustment that accounts for the temporary and supplemental 3% increase observed in 2022.
Program Updates and Expansions The rules and requirements for established programs such as RPM (Remote Patient Monitoring), Chronic Care Management (CCM), Principal Care Management (PCM), Transitional Care Management (TCM), and Annual Wellness Visits (AWVs) largely remain consistent with the previous year. However, several noteworthy changes have been introduced, including the expansion of Remote Therapeutic Monitoring (RTM), the introduction of Chronic Pain Management (CPM), and further developments in General Behavioral Health Integration (GBHI).
Rate Increases for AWVs and TCM Additional rate increases have been implemented in 2023, specifically within AWVs and TCM. This includes an increase in reimbursement value for certain billing codes, ultimately benefitting healthcare providers.
Impact on Rural Health Clinics and FQHCs Furthermore, notable changes have been made concerning Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) in 2023. Although there is a nominal increase in reimbursement value for some billing codes, the ability to bill for RPM and RTM remains restricted.
In conclusion, the CMS 2023 final rule introduces several important changes that impact healthcare providers. While some programs witness slight reductions in reimbursements, others experience rate increases and expanded billing opportunities. The evolving landscape of care management programs demonstrates CMS's commitment to enhancing patient care and provider revenue. Stay informed and actively engage in rulemaking processes to optimize your practice's approach to these transformative changes.
Disclaimer: This article is provided for informational purposes only and should not be construed as legal, billing, or professional advice. The billing and coding requirements for RPM services may undergo rapid changes. It is advisable to seek guidance from a qualified medical billing professional before submitting claims for services to ensure compliance with all current requirements.