CMS released its proposed rules for CY 2022. APTA has responded to each of these and be aware they are not yet finalized, however, the takeaway is that each of these issues will be addressed. September 13, 2021, is the final date for all comments to be received. Typically the final fee schedule is released in early November. Below is some of the information that has been released.
CY 2022 Fee Schedule is slated for a reduction. APTA estimates that physical therapy will see an approximate 3.5% reduction in payment in 2022 compared to 2021. OT will see an approximate 3.9% reduction in payment in 2022 compared to 2021. Speech therapy will see an approximate 3.8% reduction in payment in 2022 compared to 2021. These estimates of course depend on which CPT codes you bill and what percentage of each CPT code that you bill.
PTA / OTA 15% reduction is slated to be applied in CY 2022. Approximately $3.55 will be reduced per unit from the allowed amount.
Telehealth – at this time, Medicare is purposing NOT to add physical, occupational, and speech telehealth codes to their schedule. These codes include: 90901, 90912, 90913, 92607, 92608, 92609, 97110, 97112, 97116, 97150, 97161-97164, 97530, 97535, 97537, 97542, 97750, 97755, and 97763.
Supervision - CMS is seeking comment on whether this flexibility should potentially be made permanent, meaning that we would revise the definition of “direct supervision” at § 410.32(b)(3)(ii) to include immediate availability through the virtual presence of the supervising physician or a practitioner using real-time, interactive audio/video communications technology without limitation after the PHE for COVID-19, or if we should continue the policy in place for a short additional time to facilitate a gradual sunset of the policy.
CMS is also seeking comment regarding the possibility of permanently allowing immediate availability for direct supervision through virtual presence using real-time audio/video technology for only a subset of services, as they recognize that it may be inappropriate to allow direct supervision without physical presence for some services, due to potential concerns over patient safety if the practitioner is not immediately available in-person. CMS is also seeking comment on, were this policy to be made permanent, if a service level modifier should be required to identify when the requirements for direct supervision were met using two-way, audio/video communications technology.
MIPS – there is a lot of changes upcoming with MIPS. None of which is finalized and we can expect many changes yet to come before the new year. Below are just a few (from pages of purposed changes) that I thought would be most relevant to those that are currently reporting. Having said that the option of not reporting may not be an option in the upcoming years.
- Performance threshold of 75 points to avoid a negative payment adjustment in calendar year 2024
- Exceptional performance threshold of 89 points
- Removal of Measure 154 from the PT/OT Specialty Set beginning with the 2022 Performance Period
- Small practices who report Medicare Part B measures would now have to indicate if they want to report and be scored as a group instead of as an individual. This proposal would not apply to small practices participating in MIPS as part of a virtual group, because clinicians signal their intent to be scored as a virtual group through the virtual group election process.
- 7 initial MIPS Value Pathways for implementation in CY 2023 performance period
- Retiring traditional MIPS after the 2027 Performance Period and replaced in 2028 by MIPS Value Pathways
- For the 2022 Performance Period, CMS is proposing to add 5 new Quality Measures, remove 19 Quality Measures and make substantive changes to 84 Quality Measures
- For the 2022 Performance Period, CMS is proposing to add 7 new improvement activities, modify 15 existing improvement activities, and remove 6 previously adopted improvement activities
- To continue the existing policy of reweighting the Promoting Interoperability performance category and cost category for physical therapists, occupational therapists, qualified speech-language pathologist, and qualified audiologists for the 2022 performance period/2024 MIPS payment year
- CMS is proposing that for MIPS eligible clinicians in small practices when both the cost performance category and the Promoting Interoperability performance category are reweighted, the quality performance category will be weighted at 50 percent and the improvement activities performance category will be weighted at 50 percent. For non-small practices, when both the cost performance category and the Promoting Interoperability performance category are reweighted, the quality performance category will be weighted at 85 percent and the improvement activities performance category will be weighted at 15 percent.
- For the 2022 performance period/2024 MIPS payment year, CMS proposes to remove 3- point floor for each quality measure that can be reliably scored against the benchmark, meets the case minimum requirement and meets the data completeness requirement and score the quality measure from 1 to 10 points
- CMS is proposing a 5-point floor for new quality measures in the program for all collection types for their first 2 years in the program, as well as a new class for these quality measures. Measures in either their first or second performance period in the program will be classified as class 4 measures. Measures that can be reliably scored against a benchmark because they meet data completeness requirement can have a performance period benchmark calculated, and meet case minimum requirements will be considered class 4a and scored from 5 to 10 measure achievement points. In the event that a measure cannot be reliably scored against a benchmark because it lacks a benchmark or does not meet case minimum, but meets the data completeness requirement, it will be considered class 4b and receive a score of 5. Measures that cannot be scored because they do not meet the data completeness requirement will remain subject to the class 3 measure policy and receive a score of 0 for clinicians other than small practices, while small practices will continue to receive 3 points
- MIPS eligible clinicians receive 3 quality measure achievement points for each submitted measure that meets the data completeness requirement, but does not have a benchmark or meet the case minimum requirement if they are a small practice and 0 quality measure achievement points if they are not a small practice
- MIPS eligible clinicians receive no more than 7 measure achievement points for each measure (except for measures in the CMS Web Interface) for which the applicable benchmark is identified as topped out for 2 or more consecutive years based on the historical benchmarks published for the CY 2021 MIPS performance period and continues to be identified as topped out based on the performance period benchmarks published for the CY 2022 MIPS performance period/2024 MIPS payment year
- CMS is proposing to end the high-priority measure bonus points beginning with the 2022 Performance Period
- For the 2022 MIPS Performance Period/2024 MIPS Payment Year, CMS is proposing a -9% negative payment adjustment for a MIPS final score between 0.0-18.75
- For the 2022 MIPS Performance Period/2024 MIPS Payment Year, CMS is proposing greater than negative 9% and less than 0% payment adjustment on a linear sliding scale for a MIPS final score between 18.75-74.99
- For the 2022 MIPS Performance Period/2024 MIPS Payment Year, CMS is proposing a neutral payment adjustment for a MIPS final score of 75.00
- For the 2022 MIPS Performance Period/2024 MIPS Payment Year, CMS is proposing a positive MIPS payment adjustment greater than 0% on a linear sliding scale. The linear sliding scale ranges from 0 to 9% for scores from 75.00 to 100.00.
- In addition, for final score points between 89-100, CMS is proposing an additional MIPS payment adjustment for exceptional performance. The additional MIPS payment adjustment starts at 0.5% and increases on a linear sliding scale. The linear sliding scale ranges from 0.5 to 10% for scores from 89.00 to 100.00.
- CMS is proposing that when there is more than one final score associated with a TIN/NPI and the TIN/NPI is in a virtual group, the virtual group final score will be used to determine payment adjustment
- CMS is proposing that when there is more than one final score associated with a TIN/NPI and the TIN/NPI is not in a virtual group, the highest of all available scores will be used to determine payment adjustment