On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-1784-P] Proposed Rule, which includes proposals related to Medicare physician payment and the Quality Payment Program (QPP). Physicians and other clinicians are once again facing large, proposed cuts of more than 3.36% for CY 2024. While Congress has provided temporary partial fixes to physician payment in the last several years, its latest fix in the Consolidated Appropriations Act, 2023 (CAA, 2023), enacted at the end of 2022, does not offset all the proposed cuts in this rule. In all, the budget neutrality constraints of the fee schedule continue to result in a negative proposed conversion factor (CF) update. Beyond the cut to the CF, CMS proposes significant policies related to telehealth services, updates to the Medicare Shared Savings Program (MSSP), initiatives promoting health equity and other changes to further develop physician quality initiatives.
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Key takeaways from the CY 2024 PFS Proposed Rule:
- CF Reduction: Proposes a 2024 CF of $32.7476, representing a 3.36% reduction from the 2023 physician CF of $33.8872, and a 2024 anesthesia CF of $20.4370, representing a 3.26% reduction from the 2023 anesthesia CF of $21.1249
- Add-on Code for Complexity: Would implement a new add-on code for complexity, G2211, that was previously finalized but delayed by Congress until 2024
- Behavioral and Social Needs: Outlines policies to promote behavioral healthcare and services addressing health-related social needs
- Telehealth: Proposes a new process for adding, removing or otherwise changing codes on the Medicare Telehealth Service list, and would create differential payment based on the place of service
- Merit-Based Incentive Payment System (MIPS): Would raise the MIPS performance threshold to 82 points in 2024, from 75 points in both 2022 and 2023
- Appropriate Use Criteria (AUC) Program: Would permanently sunset the AUC program
- MSSP: Proposes changes to the MSSP, including to the financial benchmarking methodology, assignment methodology and more.
Comments on the proposed rule are due on September 11, 2023.
- The proposed regulation is available here.
- The press release is available here.
- The fact sheet on payment policies is available here.
- The QPP factsheet is available here.
- The MSSP factsheet is available here.
For more information, contact: Emily R. Curran (McDermott Will & Emery – Associate), Jeffrey Davis, Leigh Feldman, Deborah Godes, Kayla Holgash, Rachel Hollander, Lauren Knizner, Marie Knoll, Kristen O’Brien, Rachel Stauffer or Devin Stone.