Census Bureau NAICS 6211 Offices of Physicians to estimate base year expenses. Updated Medicare Economic Index (MEI) for CY 2023ĬMS has also proposed revising the MEI cost share rates for next year, recommending leveraging data from the U.S. A $1.53 decrease in the conversion factor to $33.08, which was $34.61 in CY 2022.Expiration of the 3% increase in PFS payments (from CY 2022). The required statutory update to the conversion factor of 0%.The first series of standard technical proposals include practice expense as well as implementation of year two of the clinical labor pricing rate. CY 2023 PFS Ratesetting and Conversion Factor In July 2022, CMS issued proposed rule updates designed to create a more equitable healthcare system reflecting improved accessibility, affordability, innovation and quality. Its president and CEO, Clif Gaus, Sc.D., said, “On balance, we believe this final rule will grow participation in accountable care organizations, which have already generated billions of dollars of savings for our health system.” Select Updates Proposed by Centers for Medicare & Medicaid Services The National Association of ACOs, however, disagrees. President of the American Academy of Family Physicians, Tochi Iroku-Malize, MD, FAAFP, agreed, saying the Rule will “result in unsustainable Medicare payment cuts for family physicians and put patients’ timely access to essential primary care at risk.” Jack Resneck, Jr., president of the American Medical Association said, “The rate cuts would create immediate financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians… physician Medicare payments are planned to be cut by nearly 8.5% in 2023…which would severely impede patient access to care due to the forced closure of physician practices and put further strain on those that remained open during the pandemic.” Physician’s groups - everyone from surgeons and chiropractors to physical therapists and others - have expressed strong opposition. So what does this mean for doctors? It’s anticipated they’ll see a 4.4% reduction in Medicare reimbursements - possibly cuts of up to 8.4% after other cuts are factored - in 2023. To adjust variants in costs based on geography, PFS relies on geographic adjusters, calculating rates with this conversion factor. Reimbursement bases payments on resources used to treat the patients, and PFS applies relative value units (RUVs) to each practice or malpractice expense and all services provided. Suppliers frequently bill the technical component - think independent diagnostic testing, radiation treatment, etc. - whereas physicians bill the professional component. PFS pays separately for diagnostic tests and other services. The PFS rates paid to those in facility settings like an ASC or hospital outpatient department typically reflect only a portion of services the practitioner provides. Generally, Medicare uses a single rate - based on full range of resources used to provide the service - to pay physicians and other professionals in the physician’s office. The PFS under Medicare reimburses physicians, technical service suppliers and other billing professionals in many different settings including: The 2023 Medicare Physician Payment Schedule (PFS) is bringing many changes to the program, including telehealth and evaluation-and-management (E/M) services and payment cuts.
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