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Get to Know the Medicare Physician Fee Schedule

 
The Centers for Medicare and Medicaid Services (CMS) published the final fee schedule for calendar year 2023 last week. Read on to learn more about the Physician Fee Schedule and what recent updates mean for health centers in this week's TPCA Policy Blog.
 
What is the Medicare Physician Fee Schedule? 
Medicare is the federal health insurance program that primarily covers people 65 and older, some folks with disabilities, and folks with End-Stage Renal Disease.1 Every year, the Centers for Medicare and Medicaid Services (CMS) publishes a regulation that makes adjustments to physician reimbursement and other health care policies under the Medicare program. CMS published the Calendar Year 2023 Medicare Physician Fee Schedule last week, which finalized proposals intended to expand access to care and make changes to care delivery and payment.  
 
How are health centers affected by the CY2023 Medicare Physician Fee Schedule? 
Community health centers in Tennessee served more than 437,000 patients in 2021, 13% of whom are covered by Medicare.2 Although the Calendar Year 2023 Medicare Physician Fee Schedule (PFS) makes changes across a variety of health care services, health centers and their patients will experience the most effects from changes to behavioral health and chronic pain management, dental services, audiology services, and Accountable Care Organizations (ACOs). 
 
Behavioral Health and Chronic Pain Management 
Community health centers integrate primary care with other health care services, including behavioral health care in which medical and behavioral health providers work together to address patients' needs. Under the CY23 PFS, beginning January 1, 2023, community health centers and rural health clinics will be reimbursed for General Behavioral Health Integration and Chronic Pain Management services using the same code for general care management services.3 Clinical psychologists and clinical social workers can be reimbursed for General Behavioral Health Integration services.4  
 
Dental Services 
Medicare currently covers a limited set of dental services, typically when dental care is a necessary component of treating a patient's primary medical condition.5 The CY23 PFS expanded the dental services that will be covered to include dental care involved in treatment of organ transplants, and cardiac valve replacements and repairs.6  
 
Audiology Services 
The CY23 PFS will permit Medicare beneficiaries to see an audiologist once per year without first obtaining an order from a physician or non-physician provider for non-acute conditions.7  
 
Accountable Care Organizations 
Community health centers are located in underserved urban and rural communities and care for the most vulnerable patients. The PFS will implement changes to Accountable Care Organizations (ACOs) to ensure rural and underserved patients are included in Medicare ACOs. ACOs are groups of providers who work together and are held to certain standards for patient experience, and the quality and cost of care.8 Several policies under the CY23 PFS will facilitate the inclusion of underserved patients in ACOs, such as:  
  • Advanced shared savings payments to certain ACOs that care for underserved patients- payments can be used to address the social needs of Medicare beneficiaries not only medical needs9 
  • Increased time before these ACOs would be required to take on downside risk10 
  • Adjustments to quality scores to account for health equity11  
The Medicare Physician Fee Schedule is a sweeping rule that affects many aspects of health care delivery and payment under the Medicare program. The adjustments that affect health centers and their patients are intended to expand access to care, improve care coordination, and ensure high quality care for all patients. 
 
 
 
[1]  Medicare. What's Medicare? Medicare. (n.d.). Retrieved from https://www.medicare.gov/what-medicare covers/your medicare-coverage-choices/whats-medicare
[2]  HRSA. Tennessee Health Center Program Uniform Data System. (n.d.) Tennessee Health Center Program Uniform Data System (UDS) data. Retrieved from https://data.hrsa.gov/tools/data-reporting/program-data/state/TN 
[3]  CMS. (2022, November 1). Fact sheet calendar year (CY) 2023 Medicare physician fee schedule final rule - medicare shared savings program. CMS. Retrieved November 9, 2022, from https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule-medicare-shared-savings-program
[4]  CMS. (2022, November 1). Press Release HHS finalizes physician payment rule strengthening access to behavioral health services and whole-person care. CMS. Retrieved from https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-access-behavioral-health-services-and-whole
[5]  CMS. (2022, November 1). Fact sheet calendar year (CY) 2023 Medicare physician fee schedule final rule - medicare shared savings program. CMS. Retrieved November 9, 2022, from https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule-medicare-shared-savings-program 
[6]  Ibid.
[7]  Ibid.
[8]  CMS. (2022, November 1). Press Release HHS finalizes physician payment rule strengthening access to behavioral health services and whole-person care. CMS. Retrieved from https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-access-behavioral-health-services-and-whole 
[9]  CMS. (2022, November 1). Press Release HHS finalizes physician payment rule strengthening access to behavioral health services and whole-person care. CMS. Retrieved from https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-access-behavioral-health-services-and-whole
[10]  Ibid.
[11]  Ibid.
 
 
 

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