By Devin Partida, Editor-in-Chief, ReHack.com
Twitter: @rehackmagazine
Health care payments have undergone a tumultuous period in the past two years. Amid the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has adjusted multiple policies and implemented several new ones.
These changes that seek to improve patient care and accessibility have considerable impacts on health care professionals. Medical organizations must stay up to date on these developments to inform their finances in the coming months and years.
Here are four of the most notable changes to CMS payment processing this year.
1. Quality Payment Program Changes
CMS released several proposed changes in July in the interest of making health care more equitable. One of the most significant of these is a set of updates to the Quality Payment Program (QPP). If these updates go through, clinicians will have to meet higher performance thresholds to qualify for the QPP’s financial incentives.
The proposed QPP changes also include expanding the definition of eligible clinicians to include clinical social workers and nurse-midwives. This change extends QPP financial benefits to professionals who previously couldn’t access them, which could help some medical organizations. Physicians assistants will also be able to bill Medicare directly, removing some administrative obstacles.
2. End of CAA 2021 Relief
The Consolidated Appropriations Act (CAA) 2021 added $3 billion in funding for the pathology field. This bump offset earlier CMS updates that would have resulted in a 9% decrease in Medicare payments for pathology. As 2021 draws to a close, pathologists should recognize that this relief may end soon.
CAA 2021 expires at the end of this year, so the previous changes may take effect without additional legislation. As a result, pathologists may have to prepare for a decrease in Medicare payments as the late 2020 CMS updates called for. Medical organizations in this field will have to look for other ways to mitigate the new expenses that follow.
3. Increased Telehealth Support
Another provision in CMS’s proposed updates is an increase in funding for telehealth services. This is not surprising considering that telemedicine visits rose by 50% in the first quarter of 2020 and continued to grow. What may be less expected is that most of these proposed changes are for mental health visits.
If these updates go through, CMS will allow Medicare to pay for mental health visits that take place over telecommunications services. Similarly, CMS proposes authorizing payment for some behavioral health practitioners for audio-only telehealth visits. Both of these would be a first for CMS and could significantly expand Medicare funding.
4. Expanded Vaccine Payments
In another COVID-inspired change, CMS has proposed to expand payments for vaccinations. Provisions already exist to cover COVID-19 vaccines, but CMS wants to update payment rates for other common vaccines as well. They would adjust rates for flu, pneumonia and hepatitis B shots, which CMS says have fallen 30% over the last seven years.
CMS is looking for information from health care organizations about the types of providers that offer these vaccinations. With that data, the agency hopes to adjust vaccine payment rates more effectively. It’s also asking for feedback on its recent $35 add-on for providers who vaccinate some underserved patients in their homes.
Several Changes Are Coming to CMS Payment Processing
The medical industry has seen some substantial changes in the past two years at the hands of the COVID-19 pandemic. Naturally, these shifts have impacted CMS payment processing as the agency adjusts to COVID-era disruptions and trends. These shifts could have lasting impacts on health care organizations’ finances.
Many of these changes are still just proposed updates. Health care providers will have to stay abreast of any further developments to know how they should adapt in 2022 and beyond.