News: CMS releases final payment rules for 2023

2023 annual payment updates for physicians, the Medicare shared savings program, and outpatient and home health services have all been published by CMS on October 31, 2022.

For the Physician Fee Schedule rule, the agency lowered the conversion factor used to calculate physician reimbursement from $34.61 to $33.06, a 4.5% decrease. It also finalized several telehealth policies, such as extending many telehealth services made temporarily available during the public health emergency until at least 2023. CMS said this will provide more time to collect data to support making them permanent additions to its telehealth services list, Becker’s Hospital Review reported.

The agency also said it will allow behavioral health services to be provided under the supervision of a physician or nonphysician practitioner when provided by auxiliary personnel (e.g., licensed professional counselors or family and marriage therapists), instead of under direct supervision.

CMS established things such as a new Medicare provider type called rural emergency hospitals in the Rural Emergency Hospitals rule, in an attempt to address concerns of rural and critical access hospital closures reducing rural patients’ access to care. The Home Health Prospective Payment System rule  focused on regulating CMS payments to home health agencies, with a 0.7% boost to their Medicare payments and a 3.5% drop under the new patient-driven groupings model. CMS plans on making cuts in the future as well as finalizing a budget-neutral 5% cap on negative wage index changes so home health payments are more predictable.

Last, for the Outpatient Prospective Payment System rule, Becker’s Hospital Review highlighted the following changes:

• Outpatient payment rates increased for hospitals that meet applicable quality reporting requirements by 3.8%
• Pay rates increased by 3.8% for ambulatory surgical centers that meet applicable quality reporting requirements
• A general payment rate finalized of average sale price plus 6% for drugs and biologicals acquired through the 340B drug pricing program

Editor’s note: To read Becker’s Hospital Review’s coverage of this story, click here.