2023 MPFS Final Rule Has Implications for E/M Coding, Colorectal Cancer Screening
The 2023 MPFS final rule included several provisions that the College recommended in comments submitted September 6 in response to the Agency’s MPFS proposed rule issued.
CMS finalized a policy in 2021 that the billing provider of a split (or shared) evaluation and management (E/M) visit is the provider who spent more than half of the total time with a patient during the visit. CMS will delay implementation of this policy until 2024, and providers who furnish split/shared visits will continue to have a choice of history, physical exam, medical decision-making, or more than half of the total practitioner time spent to determine which provider may bill for the service. The agency also finalized refinements to coding and documentation requirements for hospital inpatient, observation, emergency department, and other E/M visits for 2023.
To broaden Medicare coverage of colorectal cancer (CRC) screening tests, CMS reduced the minimum age payment limitation from 50 to 45 years. The agency will also pay for follow up colonoscopies as screening tests—rather than diagnostic tests—when they are furnished after a non-invasive stool-based screening test (such as Cologuard) to reduce patients’ out-of-pocket costs for CRC testing. Additionally, CMS will allow certain services added to the Medicare telehealth covered services list during the COVID-19 pandemic to remain on the list for 151 days after the expiration of the PHE.
The MPFS final rule and related fact sheet are available online for public review. Contact lfoe@facs.org for more information.
Review New Policies for 2023 Quality Payment Program
Also within the 2023 MPFS final rule, CMS released finalized provisions for the CY 2023 Quality Payment Program (QPP). Required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), QPP implementation began in 2017. The QPP offers two pathways for providers who participate in Medicare: the Merit-based Incentive Payment System (MIPS), and Advanced Alternative Payment Models (APMs). Performance in MIPS in 2023 can result in payment adjustments of up to +/- 9% in 2025.
For the 2023 performance year (2025 payment year), CMS finalized multiple MIPS policies; however, many of the major MIPS policies remain the same from 2022 to 2023. The performance threshold required to avoid a penalty in 2025 remains at 75 points, and the performance category weights are unchanged at these values:
- Quality: 30%
- Cost 30%
- Improvement Activities (IA): 15%
- Promoting Interoperability (PI): 25%.
CMS also finalized, beginning in 2023, facility-based clinicians becoming eligible for the complex patient bonus even if they do not submit MIPS data. Clinicians can use the QPP Participation Lookup tool to determine if they meet the facility-based clinician definition.
In addition to updates to traditional MIPS, CMS finalized five additional MIPS Value Pathways (MVPs) to be available on a voluntary basis starting with the 2023 performance year, making 13 MVPs available for reporting in 2023. MVPs are a new MIPS reporting pathway that aims to align measures and activities across the noted performance categories to simplify MIPS, with the goal of creating more meaningful set of measures centered around an episode of care or condition. MVPs are also intended to create a glidepath toward utilizing APMs.
Beginning in 2023, subgroup reporting will also be available for those reporting MVPs. Through subgroup reporting, multispecialty groups can create subgroups to report performance information that is more meaningful to the care they deliver as a team.
The ACS is evaluating the final rule and will submit comments to CMS where appropriate. The final rule is available for public review, along with resources on its QPP provisions. Contact qualityDC@facs.org for more information.
Access Your MIPS Performance Feedback for Performance Year 2021
Surgeons can now review their 2021 MIPS performance feedback on the QPP website. Performance Feedback reports includes your 2021 MIPS final scores and corresponding 2023 MIPS payment adjustment information. As a reminder, MIPS final scores are calculated based on your performance in the Quality, IA, Cost, and PI categories. To access your information, you must sign into your QPP account. Once logged in, MIPS-eligible surgeons can view measure-level performance data, payment adjustment information, performance category weights, and more.
For performance year 2021, the MIPS performance threshold was set at 60 points, meaning that surgeons’ combined score on all four MIPS performance categories had to reach or exceed 60 points to avoid a negative payment adjustment in 2023. MIPS payment adjustments are determined by benchmarking a MIPS-eligible clinician’s score against the performance threshold. By statute, the maximum negative payment adjustment in 2023 is 9%.
For additional information regarding performance feedback, access these resources (note: following the links will initiate a file download):
Further questions can be directed to QualityDC@facs.org.
