Five Percent Overall Medicare Reimbursement Cut Estimated for Medical Oncology in 2022

ASCO Urges Congress to Prevent Additional Cuts Before the End of the Year

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On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) final rule. Although ASCO will analyze the rule in greater detail in the coming days, initial highlights from the rule are outlined here.

Medicare Physician Fee Schedule Updates

The 2022 Conversion Factor (CF) will be $33.59, a decrease of $1.30 from the 2021 Physician Fee Schedule conversion factor of $34.89. This 3.7% reduction in the CF is largely due to the expiration of the 3.75% temporary payment increase provided by the Consolidated Appropriations Act (CAA) in 2021.

Specialty Impact

ASCO estimates a 5% overall reimbursement cut for the medical oncology specialty stemming from the fee schedule in 2022 based on updates to Relative Value Units (RVUs) and the updated CF. The actual impact on individual clinicians, however, will vary based on geographic location and the mix of Medicare services billed.

Additionally, that estimate does not include the expiration of the Medicare sequestration moratorium (an additional 2% overall cut) and the statutory sequestration (a further 4% cut overall) set to take effect January 1, 2022.

As 2021 comes to an end, so does the deadline for Congress to take action on the looming sequestration cuts to Medicare reimbursement. ASCO urges Congress to prevent this impending Medicare payment crisis through legislation. ASCO members are encouraged to contact their lawmakers and ask them to support providers, and patient access to care, by stopping additional cuts to Medicare reimbursement before the end of the year.

ASCO will complete a full specialty impact analysis in the coming weeks as the Association looks more deeply into the final rule.

Clinical Labor

CMS will move forward with updates to the Clinical Labor rates and will phase in the updates over 4 years to transition from the current rates to the final updated prices in 2025. CMS is following the same implementation methodology it did for updated supply and equipment prices.

Split or Shared Evaluation and Management (E&M) Services: CMS is updating the definition of split (or shared) E&M visits provided in the facility setting to include a physician and a nonphysician practitioner (NPP) in the same group. The split or shared E&M visit is billed by the physician or practitioner who provides the substantive portion of the visit, which in 2023 will be more than half of the total time spent. Split or shared visits can be reported for new as well as established patients, and initial and subsequent visits, as well as prolonged services.

Telehealth: CMS finalized its proposal to allow certain services added to the Medicare telehealth list temporarily during the COVID-19 public health emergency (PHE) to remain until December 31, 2023. CMS will continue to evaluate whether the services should be permanently added to the telehealth list after the PHE is lifted. CMS also adopted permanent coding and reimbursement for a virtual check-in (audio-only) service.

CMS is implementing provisions of Section 123 of the CAA by removing geographic restrictions and adding the home of the beneficiary as a permissible originating site for telehealth services furnished for the purposes of diagnosis, evaluation, or treatment of a mental health disorder. CMS also finalized its proposal to allow audio-only communication for mental health services furnished by practitioners who have the capability of furnishing two-way audio/video communications, but where the beneficiary is not capable of, or does not consent to, the use of two-way audio/video technology.

Billing for Physician Assistant (PA) Services: CMS is implementing section 403 of the CAA, which authorizes Medicare to make direct payment to PAs for professional services they furnish under Medicare Part B beginning January 1, 2022. Medicare currently can only make payment to the employer or independent contractor of a PA. Beginning January 1, 2022, PAs may bill Medicare directly for their professional services, reassign payment for their professional services, and incorporate with other PAs and bill Medicare for PA services.

Colorectal Cancer Screening: CMS finalized implementation of Section 122 of the CAA, which provides a special coinsurance rule for procedures that are planned as colorectal cancer screening tests but become diagnostic tests when the practitioner identifies the need for additional services (eg, removal of polyps). Beginning in 2022, the coinsurance required of Medicare beneficiaries for planned colorectal cancer screening tests that result in additional procedures furnished in the same clinical encounter will be gradually reduced from 20% on January 1, 2022, to 0% on January 1, 2030.

Appropriate Use Criteria (AUC) Program: CMS finalized the proposal to begin the payment penalty phase of the AUC program on the later of January 1, 2023, or the January 1 that follows the declared end of the PHE for COVID-19. This flexible effective date is intended to take into account the impact that the PHE for COVID-19 has had and may continue to have on practitioners, providers, and beneficiaries. Previously, the payment penalty phase of the AUC program was set to begin January 1, 2022.

Quality Payment Program Updates

CMSis finalizing its proposal to move to Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) in 2023. For performance year 2023, CMS finalized seven MVPs in the areas of rheumatology, stroke, heart disease, chronic disease management, emergency medicine, lower extremity joint repair, and anesthesia.

For the 2023, 2024, and 2025 performance years, MVP participants are identified as individual clinicians, single specialty groups, multispecialty groups, subgroups, and alternative payment model (APM) entities that are assessed on an MVP for all MIPS performance categories. Beginning in the 2026 performance year, multispecialty groups will be required to form subgroups to report under MVPs.

Other key QPP policy updates for 2022 include the following: revising the definition of a MIPS eligible clinician to include social workers and certified nurse mid-wives; setting the MIPS performance threshold at 75 points and the exceptional performance threshold at 89 points; weighting the cost and quality performance categories equally (as statutorily required) at 30%; and extending the CMS Web Interface as a collection type and submission type in traditional MIPS for registered groups, virtual groups, and APM Entities for the 2022 performance year only. 

© 2021. American Society of Clinical Oncology. All rights reserved.