The panel was back at it with a great breakdown of the Medicare Physician Fee Schedule Rule Changes for 2024... as always it was a lively discussion about the proposed rule changes and their impact on providers.

Topics Included:

1. Split/shared services – the definition of substantive portion will remain the same as it is now through 12/31/2024... Time will not be the controlling factor. HX, EX, and MDM can be used to make this determination of the substantive portion.

2. Extend flexibilities for certain assessments furnished via audio-only communication, through the end of CY 2024. If finalized, opioid treatment programs (OTPs) would be allowed to bill Medicare when video is not available, using technology permitted by the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Administration (SAMHSA). This extension would equalize telehealth flexibilities across providers of care and negate potential service disruptions due to the end of the COVID-19 public health emergency (PHE).

3. CMS proposes several additions to covered telehealth services under the MPFS, as well as an extension of several telehealth provisions from the Consolidated Appropriations Act (CAA) of 2023. Proposed changes include the add-on of health and well-being coaching services on a temporary basis (specific diagnoses and licensure/certifications will apply), as well as a refined process to review requests to add services to the Medicare Telehealth Services List. Telehealth provisions extended through December 31, 2024, will include:

• The temporary expansion of the scope of sites where telehealth is furnished from, to include any location in the U.S. where a beneficiary may reside; for Medicare and MA patients, but States would also have to agree to comply.

• A change in definition of telehealth providers to include qualified audiologists, speech-language pathologists, occupational therapists, and physical therapists; They are already on the Temp list through 2024

• Continued payment for telehealth services provided by federally qualified health centers (FQHCs) and rural health centers (RHCs); limited to BH services

• Delaying requirements for beneficiaries to meet with practitioners six months before initiating mental health telehealth services; Unless they have a narcotic prescription then they would not qualify if a new patient after Nov 2023

• Allowing physicians in teaching environments to use video and audio communications when a resident is furnishing Medicare telehealth services; and But the supervising provider would have to be somewhere in the inpatient hospital setting and available if needed.

• Continued payment and coverage of telehealth services that are included on the Medicare Telehealth Services List.

4. There is a proposed reduction to the 2024 conversion factor that would reduce provider reimbursement. CMS is urging Congress to create a permanent fix for this issue but as it stands now, the proposed rate reduction stands. CMS is also proposing significant increases in payment for primary care and other kinds of direct patient care with the HCPCS add on G2211.

5. The proposed rule includes a new benefit category wherein family therapists, marriage therapists, and mental health counselors would be able to bill Medicare (Physician supervision necessary). Additionally, CMS proposes changes in payment and coding to account for resources utilized in the delivery of care involving a multidisciplinary clinical team and other staff members.

6. The Proposed Rule has significant implications for other virtual care and care management services, including Remote Physiologic Monitoring (“RPM”) and Remote Therapeutic Monitoring (“RTM”) services. Below is a summary of key provisions in the Proposed Rule relating to RPM, RTM, and other virtual care management services, along with opportunities and challenges for stakeholders in the space.