Congressional Spending Bill Partially Averts Cut to Medicare Physician Payment

Last week, the Senate passed its $1.7 trillion fiscal year Omnibus Appropriations Bill. The bill averted the scheduled bigger cuts, but the compromise includes a 2% cut in Medicare payments for 2023 and a 1.25% cut in 2024. On the positive side, the budget deal also includes a two-year postponement of the 4% in cuts from the pay-go sequester that came from the American Recue Plan.  

Despite the overall Medicare cut, PALTC-based Medicare billing clinicians will still see a significant increase for their nursing home visits. As a result of AMDA’s work, CMS finalized significant increases to nursing facility relative value units (RVUs). AMDA estimated payment rates for each of the codes back in November and once the final conversion factor is known, we will update these figures. AMDA has continued to stress that there needs to be a permanent solution to the Medicare payment issue. For more than 20 years, Congress has had to step in to avert Medicare cuts and it is time to find long-term solutions that stabilize these payment rates and ensure access to quality PALTC services for millions of Americans. Given the severe careforce staffing crisis in this setting, developing such a solution is paramount. AMDA has heard many reports about the difficulties of finding physicians to see patients and/or serve as facility medical directors in many parts of the country. AMDA calls for a significant investment in this careforce and a better understanding of the scope of this problem.

In addition to the payment changes, this year CMS finalized changes in coding and values for the proposed revised Nursing Facility Visits E/M code set. This code set is effective beginning in CY 2023, and the proposed values will go into effect with those codes as of January 1, 2023

In order to help members better prepare for the 2023 changes to coding and documentation guidance for current procedural terminology (CPT) evaluation and management services in PALTC, the Society continues to make available the popular November webinar discussing the changes. The 2023 revisions to CPT evaluation and management services, including those for nursing facility services and assisted living facility services, will be among the most significant changes to CPT descriptors in decades.

The AMDA webinar focuses on those changes as well as other important aspects of documentation and coding in PALTC. The goal of the webinar is to help prepare participants to implement 2023 coding and documentation guidance for CPT evaluation and management services in PALTC. Access the webinar now; it is free for members.

Part two of the webinar will be held January 24. Get more information and register.