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2023 Medicare Physician Billing Policies You Might Not Be Aware Of

Billing and coding are payment pipelines. If there is a hole on any side of the pipe, water can leak without our knowledge; similarly, a minor code error can leave your money leaking.

The various codes and billing standards help to clarify the specific treatments. Also, as innovations and therapies emerge, a new set of guidelines is always required. The Medicare Physician Fee Schedule, which is modified annually by CMS, serves as the foundation for healthcare policy and reimbursements. These regulations primarily address Medicare billing standards, payment value, and insurance beneficiaries; however, they also touch on Medicaid and commercial insurance needs for the upcoming year.

On January 1, 2023, new guidelines for Medicare Physician Fee Schedule (MPFS) kicked in, which was released on 1st November 2022.

Look at the below listed revised rules that will influence Medicare practitioners for different practice services.

Evaluation and Management (E/M) Services

Continuous revisions of E/M service codes and related coding parameters are to minimize administrative burden. Here are some noticeable coding changes:

  • The new set of descriptors to code for time duration.
  • Revised guidelines are framed to expand the scope of taking clinical decisions.
  • History and examinations will no longer be used to define code level. However, providers must ensure that they obtain relevant history and conduct a thorough examination of the patient’s health status.
  • Three latest codes for prolonged services G0316, G0317, and G0318 have been reactivated effective 2023.
  • CPTs for Inpatient and observation codes for hospitals have been merged into a single code family which is 99221-99223 for Initial Visit and 99231-99233 for Subsequent Visits.
  • You can utilize the emergency care code (99281) to indicate visits that do not require a physician’s presence and which are self- limited.

Telehealth Services

The arrival of COVID made way for new services. Some treatment services added to Medicare coverage, including telephonic visits.

In PHE (Public Health Emergency), these services are delivered as telehealth services. Including them for the year 2023 will provide extra time to gather data for their inclusion in long-term Medicare Telehealth Service. The policies listed below will be in effect throughout the PHE and for the remaining 151 days after it finishes:

  • Allowing telemedicine to be delivered in all places, including the Patient’s home.
  • Enabling the offering of specific services using audio-only telecom systems.
  • The offering of telemedicine services by occupational therapists, and audiologists, will be continued.

Mental Health And Substance Abuse

CMS rule revisions are intended to enhance mental health care access. The necessity for direct supervision has been modified and this allows additional staff (certified counselors, qualified marital and family doctors) to perform treatments under the oversight of doctor, nurses, technicians, or psychologists.

Methadone is used as an opioid therapy medication. CMS is working on a plan to modify the cost structure for the medication component and also the add-on codes.

Methadone payment values for 2021 will be employed to estimate drug constituent payment values for HCPCS codes G2067 and G2078.

Patients who are under Opioid Treatment Programs (OTPs) using telemedicine for initiating buprenorphine therapy will be provided with payments.

CMS has also approved the OTP intake add-on code for buprenorphine therapy initiation when two-way communication technology is used. You can also bill OTP services that are delivered via mobile units as long as they follow SAMHSA (Substance Abuse and Mental Health Services Administration) and DEA (Drug Enforcement Administration) guidelines.

Chronic Pain Treatment Services

Chronic Pain Management (CPM) treatment services require distinct coding for payment by CMS. A physician, nurse practitioner, or other certified healthcare providers can bill for CPM services.

Updated HCPCS codes for CPM and treatments, which comprise assessment and monitoring as well as the revision and upkeeping of a patient-focused plan.

G3002 and G3003 are recently added monthly bundled HCPCS codes for the calendar year 2023 with hopes of improving accurate payments for these services.

Audiology Services

CMS permits beneficiaries to see an audiologist directly. With approved guidelines, we can employ a new modifier rather than a new HCPCS G-code to improve reporting accuracy. For services performed on or after January 1, 2023, practitioners may use modifiers AB in combination with the approved 36 CPT codes.

Newly added CPT codes for audiology services are:

  • 98978- This code denotes the use of one or more remote healing and monitoring devices for cognitive behavior therapy that comprises recording and alert sending.

CPT codes in Category III for vestibular implant programming and reprogramming are:

  • 0728T Vestibular implant diagnostic analysis, where only 1 side of the patient’s head has a vestibular device (sensors).
  • 0729T is used for additional programming in the device.

Final Thoughts

Your payment needs and updates do not end here, we have just touched a drop from the ocean of rules. Other Medicare Reimbursement Updates for your note include:

  • Per CMS press release, Medicare will pay for services, such as dental exams and treatments prior to or simultaneously with organ transplants, cardiac valve replacements, and valvuloplasty procedures.
  • The CMS Final Rule slashes cardiology reimbursement by 1% in 2023.
  • Conversion factor has been decreased to $33.06 in 2023, a drop of $1.55 from the 2022 conversion factor of $34.61.

Do you feel dizzy just by reading? Rules for medical reimbursement must change for the benefit of all. We cannot blame CMS or ourselves for the missed payment opportunities. If you feel trapped by compliance and coding, Outsourcing RCM services is the instant solution.

Practolytics is your one-stop solution for all RCM services. We perform coding and billing operations with diligence and precision. Get in touch with our team of professionals who will assist you in recovering your lost payment.

Simply notify us for assistance @ [email protected]

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