Learn How New Medicare Rules Are Changing Physician Billing

Did you know Medicare payments are being cut by 2.83%? The AMA tried to stop it, but CMS is moving forward with the reduction. You need to stay updated on these changes to adjust your physician billing and avoid claim denials while keeping your revenue strong.

Vital actions that have been implemented by CMS:

1) CMS has already rolled out suggestions coming from AMA:

You might be wondering what's happening with Medicare payments. Here's the deal—CMS is holding off on big changes to how they calculate physician payments. They're waiting for survey data on physician pay, practice costs, and hours worked. Since the survey just wrapped up last year, experts are still reviewing the results. CMS also wants to find better ways to measure practice costs and make payments more predictable. For now, they're taking their time and looking for ideas to make these updates smoother.

2) The major action on telehealth taken by CMS:

You remember how telehealth became a big deal during COVID-19, right? Medicare made special rules so you could use telehealth from anywhere, not just in rural areas. Congress had to decide whether to keep those rules, and they extended them—but only until the coming March. After that, they will have to choose again.

Good news for you! CMS now allows physicians to bill for telehealth over the phone if they cannot or do not want to use video. This is especially helpful if your patients need mental health support, substance use treatment, or regular kidney care.

3) Changes in Medicare's split/shared visit billing rules:

If your patient visited multiple providers during a visit, Medicare had to split the billing between them based on who spent the most time with your patients. CMS planned to change this, making medical decision-making the deciding factor instead of time. But they delayed this change again, so for now, you can still bill based on time spent. This gives you more flexibility in physician billing and helps avoid unnecessary payment issues.

4) More flexibility for physician assistant (PA) billing:

There is another important update for you—CMS has now made it easier for physician assistants (PAs) to bill Medicare directly. Before, PAs had to bill under a supervising physician or employer, but now they can enroll and get paid directly. This gives more flexibility in how care is billed and helps PAs take on a bigger role in your patient care.

5) Easier prior authorization for medical services:

You already know that fact that prior authorization is a complex process, and CMS is doing its best to make this process convenient and transparent for everyone. CMS is now requiring insurance companies to speed up approval time and provide sufficient reasons behind claim denials. Now, you need to spend less time dealing with paperwork so that you focus more on patient care.

6) Maintaining the thresholds for MIPS:

Medical billing is changing, and it is affecting you. CMS is keeping MIPS penalty rules the same for now due to COVID-19 and the increased number of cyberattacks. Small practices have struggled with unfair penalties and extra work, but CMS is adjusting cost calculations to make scoring fairer. Plus, they now have a rule to fix cost mistakes. Still, many believe MIPS needs bigger improvements.

Staying ahead in billing is not easy, but a trusted physician billing company can make it simple. They help you reduce claim denials, keep payments on track, and boost revenue. With experts handling your billing, you can focus more on patient care. Let a professional RCM company take over and enjoy peace of mind.