Medicare payment cut: The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule for the 2025 Medicare Physician Fee Schedule (MPFS), which includes a 2.93% average payment rate reduction for physicians. This comes despite the agency’s stated commitment to advancing health equity and supporting whole-person care through initiatives like strengthening primary care and establishing new Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) for several specialties.
Key points from the proposed rule:
- 2.93% payment rate cut: The average payment rate for physician services is set to decrease by 2.93% in 2025.
- Focus on primary care: CMS aims to strengthen primary care by establishing an advanced primary care bundle and tying services to quality measures.
- New MIPS Value Pathways: Six new MVPs will be introduced for ophthalmology, dermatology, gastroenterology, pulmonology, urology, and surgical care.
- Quality measures: CMS will continue to emphasize quality improvement and innovation through MIPS and MVPs.
The proposed rule is now open for public comment, with the final rule expected to be released later this year.
CMS Expands Coverage for Behavioral Health and Other Services:
The Centers for Medicare & Medicaid Services (CMS) is proposing several changes to improve access to care.
Expanded Behavioral Health Support:
- Suicide and overdose prevention: New payments for providers offering safety planning and follow-up care for high-risk individuals.
- Behavioral health consultations: Increased payment and coding options for specialist consultations.
- Digital tools: Potential new payment and coding for digital behavioral health treatments.
Enhanced Oral Health Coverage: CMS is proposing to cover certain dental services linked to critical medical procedures such as organ transplants, heart surgeries, cancer treatments, and dialysis.
Telehealth Flexibilities Face Uncertain Future:
The COVID-19 pandemic led to a surge in telehealth services due to temporary waivers issued by the Centers for Medicare & Medicaid Services (CMS). While some of these flexibilities, such as virtual supervision of staff and using home addresses for telehealth, may continue beyond 2024, most telehealth regulations will revert to pre-pandemic restrictions unless Congress intervenes. CMS is seeking public input on potential expansions of telehealth services under the primary care exception.
CMS Proposes Changes to Surgery Payments and CVD Risk Assessment:
The Centers for Medicare & Medicaid Services (CMS) is aiming to improve payment accuracy for surgical procedures by requiring practitioners to report specific details about patient transfers. Additionally, a new code is proposed for postoperative care provided by non-surgical physicians.
To enhance cardiovascular disease (CVD) prevention, CMS is introducing new coding and payment options for CVD risk assessments during routine check-ups. These assessments will utilize standardized tools to calculate a patient’s 10-year CVD risk.
Medicare Payment Cuts Threaten Access to Care:
The proposed 2.93% cut to Medicare payment rates for 2025 would mark the fifth consecutive year of reduced reimbursement. This comes as the cost of providing care continues to rise, with the Medicare Economic Index (MEI) projected to increase by 3.6%. This widening gap between payment rates and practice costs is unsustainable.
The American Medical Association (AMA) warns that repeated Medicare payment cuts threaten patient access to care. Physicians have endured a 29% decline in Medicare payments since 2001, adjusted for inflation.
Essential Tips for Submitting Clean Claims: Maximize Revenue with Allzone
Allzone Management Services understands the importance of clean claims in ensuring timely reimbursements and optimizing your revenue cycle. A clean claim is one that is submitted accurately and completely, without errors or omissions, leading to faster payment.
Here are some essential tips to ensure you’re submitting clean claims:
Data Accuracy and Completeness:
- Verify patient information: Ensure all patient demographics (name, date of birth, address, insurance information) are correct and up-to-date.
- Accurate coding: Use the correct ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes. Stay updated with coding guidelines and changes.
- Complete documentation: Ensure all necessary medical records and supporting documentation is attached to the claim.
Claims Submission Process:
- Follow payer guidelines: Adhere to specific payer rules and regulations regarding claim formats, submission methods, and required information.
- Timely filing: Submit claims within the payer’s specified timeframe to avoid penalties.
- Prior authorization: Obtain necessary pre-authorizations for procedures or services that require them.
- Claim scrubbing: Use software to check claims for errors before submission.
For expert assistance in streamlining your claims submission process and maximizing your revenue, contact Allzone Management Services. Our dedicated team can help you improve claim accuracy, reduce denials, and accelerate reimbursements.