CMS Physician Fee Schedule Final Rule for 2023

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Every summer CMS publishes their proposed new physician payment and coding change guidelines for the coming year. November 1, 2022, CMS published their final rule confirming or changing issues from the proposed rule. In some circumstances, provider comments can influence CMS to deviate from their original proposed guidelines. It is very important for providers and staff to know what items in the proposed rule will move forward to 2023 and to know what CMS has decided not to move forward on in 2023. The proposed rule issues that were not implemented for 2023 may identify issues still being considered for 2024. This year there are significant changes to EM services that will require a complete change in the way services are coded outside of the office setting.

Learning Objective:

• Correct coding of EM services outside of the office setting
• CMS’s new conversion factor for 2023 affect your bottom line
• Changes to colorectal cancer screening guidelines
• How shared care will change or not change for 2023
• Identify new telehealth services available after the end of PHE
• Consider the how the role of clinical psychologists, and clinical social workers, professional licensed counselors and licensed marriage and family therapists will improve access to behavioral health services
• New codes and strategies for chronic pain management
• Understand new payment methodology and codes for Methadone treatment drugs
• Review finalized guidelines for patient access to audiology services and dental oral health care.
• Understand new payment and classification of wound care management products.

Areas Covered in the Session:

• New conversion factor for 2023
• New EM codes and code categories outside of the office setting
• New times associated with EM codes
• New prolonged service G codes for Medicare patients
• Split/Shared care
• Colorectal screening guidelines
• Updated telehealth availability
• Chronic care management
• Availability for patient treatment by clinical psychologists, and clinical social workers, professional licensed counselors and licensed marriage and family therapists
• Payment for drugs for methadone treatment
• Expanded access to audiology and dental/oral health services
• Possible changes to “skin substitutes” in 2024
• 2023 Conversion Factor
• E/M Issues
• 2023 CPT E/M Changes
• Deleted Codes and Categories
• Combined Categories
• Home/Residence Services Changes
• Prolonged Services Changes
• CMS General Prolonged Services Guidelines
• AMA versus CMS Time Calculations for Prolonged Service
• CMS Prolonged Service Confusion
• CMS General Prolonged Services Guidelines
• Hospital/Observation, Nursing Facility
• Guidelines Controversy
• Colorectal Cancer Screening
• Telehealth
• Chronic Pain Management
• G0323 BHI
• Behavioral Health Services
• Opioid Treatments
• Methadone Payment Policy
• Opioid Treatment Programs
• Additional Rules
• Audiology Services
• Dental & Oral Health Services
• KX Modifier Thresholds
• Skin Substitute
• Discarded Drugs
• RHC and FQHC
• Revaluing Global Surgical Days

Suggested Attendees:

• Providers
• Coders
• Office Managers
• Denial resolution teams
• Auditors
• Insurance payers
• Payment policymakers
• Billing Staff
• Coding Staff
• Compliance officers
• Clinic Managers
• Physician and Non-physician Practitioners
• Insurance Company Claims Reviewers

Presenter Biography:

Jan Rasmussen, PCS, ACS-OB, ACS-GI, – As a healthcare consultant Jan has more than 35 years of experience in physician billing, reimbursement, and compliance. Jan is currently the owner of Professional Coding Solutions, a healthcare consulting firm. She has been a Certified Professional Coder (CPC) since 1992 with active membership in the American Academy of Procedural Coders (AAPC). As a member of the AAPC, Jan previously served on their Advisory Board as the liaison to the AMA, has been a speaker for the AAPC annual conference as well as contributing to the development of AAPC’s independent study and university education programs and proficiency tests. In 1994, she was honored by AAPC as Networker of the Year. Jan was also a Regional Governor for the American College of Medical Coding Specialists (ACMCS) serving as Chair of the Ethics committee and a member of the Examination committee.

In her role as a physician consultant, she has participated in physician coding and documentation reviews including OIG government PATH and Campus audits, and designed and conducted physician coding seminars nationwide. She has been a guest speaker for several conferences sponsored by United Communications, Inc//Decision Health, AAPC as well as Coding Institute Specialty Conferences.

In previous consulting positions she was responsible for developing and conducting seminars for basic, intermediate, and advanced ICD-9-CM and CPT, teaching physician guidelines as well as special seminars for OB/Gyn, Orthopedics, Urology, Gastroenterology, General Surgery, ENT, Cardiology, Emergency Medicine and Evaluation and Management. In her role as an educator, she has been teaching E/M documentation and auditing to both physician and coding audiences since 1992 when RBRVS was first implemented.

Jan has also worked for several major health insurance payers in Wisconsin, was a coding advisor to the WPS Medicare Carrier Advisory Committee, and served as the coding and reimbursement coordinator for a 37 provider, staff model HMO clinic. As the coding and reimbursement coordinator, Jan was responsible for physician office, hospital, surgical and nursing facility coding, charge ticket development, fee development, reimbursement analysis, claims analysis and physician education.

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