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Key changes are pending in the areas of behavioral health, cancer screening, and dental – among others.

The Centers for Medicare & Medicaid Services (CMS) has unveiled its highly anticipated 2023 Physician Fee Schedule (PFS) Final Rule, with an eye on fomenting long-term improvement in several critical areas of healthcare delivery and management.

Officials said the move is expected to increase access to behavioral health services, expand cancer screening coverage, and promote dental care, along with driving innovation and coordinated care in Medicare through Accountable Care Organizations (ACOs).

“The Biden-Harris Administration is committed to expanding access to vital prevention and treatment services,” U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra said in a statement. “Providing whole-person support and services through Medicare will improve health and well-being for millions of Americans – and even save lives.”

“Access to services promoting behavioral health, wellness, and whole-person care is key to helping people achieve the best health possible,” CMS Administrator Chiquita Brooks-LaSure added. “The Physician Fee Schedule Final Rule ensures that the people we serve will experience coordinated care and that they have access to prevention and treatment services for substance use, mental health services, crisis intervention, and pain care.”

Specifically, CMS said it will begin allowing behavioral health clinicians like licensed professional counselors and marriage and family therapists to offer services under general (rather than direct) supervision of Medicare practitioners. The agency said it is also finalizing policies to pay for clinical psychologists and licensed clinical social workers to furnish integrated behavioral healthcare as part of a primary care team. Medicare will also provide a new monthly payment for comprehensive treatment and management services for patients with chronic pain.

Officials said they are also finalizing changes to the Medicare Shared Savings Program, the nation’s largest ACO program, covering more than 11 million people with Medicare and including more than 500,000 healthcare providers.

“Through these policies, which are central to the Medicare Value-Based Care Strategy, CMS will take important steps toward our 2030 goal of having 100 percent of Traditional Medicare beneficiaries in an accountable care relationship with their healthcare provider,” the agency said in a press release. “CMS is finalizing proposals to incorporate advance shared savings payments to certain new ACOs that can be used to support their participation in the Shared Savings Program, including hiring additional staff or addressing social needs of people with Medicare.”

Longtime RACmonitor contributor Dr. Ronald Hirsch, Vice President of the Regulations and Education Group for R1 RCM Inc., said there’s another anticipated benefit to the Final Rule.

“I am delighted to see CMS adopt the physician E&M code selection changes adopted by the AMA (American Medical Association) earlier this year,” he said. “Not one person will be sad to see the rampant copy-and-paste in the medical record go away. Using one code for both observation and inpatient is also a welcome simplification for doctors, but they still must bill with the correct place of service to avoid a denial. I hope that all facilities will work with their physicians to teach the new code selection paradigm and stress the importance of meaningful documentation in the chart.”

Programming note: Listen to Monitor Monday this coming Monday, Nov. 7 and hear a live report from Colleen Deighan Ejak on the 2023 PFS Final Rule.

Resources:

To view a fact sheet on the Final Rule, go to: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule

To view the Final Rule in its entirety, go to: https://www.cms.gov/files/document/cy2023-physician-fee-schedule-final-rule-cms-1770f.pdf

Mark Spivey is a national correspondent for Auditor Monitor, RACmonitor, and ICD10monitor who has been writing and editing material about the federal oversight of American healthcare for nearly 15 years. He can be reached at mcspivey33@gmail.com.   

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Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade.

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