Medicare Reimbursement Briefing: How Will Recent Changes Affect You?

In recent weeks, there’ve been a number of significant developments, some positive, some negative, that may directly affect your Medicare reimbursement this and next year. Here’s a quick briefing on three stories lab compliance officers and business planners need to be aware of.

MedPAC Says Physicians Don’t Need a Medicare Rate Hike in 2023

There’s no compelling reason to pay physicians more next year. That was the basic conclusion of the 604-page report that the Medicare Payment Assessment Commission (MedPAC) submitted to Congress on March 15. “We expect volume and revenue to return to pre-pandemic levels (or higher) by 2023,” stated the influential panel in the report it’s legally required to give lawmakers each year. That prediction may or may not be true. What can’t be questioned is the fact that physicians have gone several years without a meaningful pay increase. The cumulative effect of no reimbursement hikes, especially during times of pandemic, seems not to have factored into MedPAC’s analysis. “Overall, access to clinician services for Medicare beneficiaries appears stable and comparable to that for privately insured individuals,” the report states. Not surprisingly, the medical industry took issue with the MedPAC recommendations, which the Medical Group Management Association (MGMA) called “deeply troubling,” given that current inflation rates are at a 40-year high and the 2 percent Medicare sequester penalty will be reinstated in a few weeks. 

Medicare Expands Coverage of Lung Cancer Screening

A national coverage determination (NCD) expanding Medicare coverage for lung cancer screening took effect on Feb. 10. The NCD:

• Lowers the starting eligibility age for screening from 55 to 50 years;
• Reduces the coverage threshold for tobacco smoking history from at least 30 pack-years to 20;
• Expands coverage for lung cancer screening using low dose computed tomography (LDCT); and
• Simplifies requirements for the counseling and shared decision-making visit.

Telehealth Expansion Bill Leaves Critical Access Hospitals Out in the Cold

The $1.5 trillion federal government spending bill that the president signed on March 15 would extend Medicare coverage of telehealth services for five additional months after the public health emergency (PHE) ends. At least that’s true for many types of providers. One group that won’t benefit, at least the way the law is currently written, is critical access hospitals (CAHs) that serve rural areas. CAHs were among the providers covered by the original coverage expansion in the early days of the PHE. And they’ve been delivering needed health to the elderly via telehealth for the past two years. But they won’t be able to get reimbursed for those services once the PHE comes to an end. CAH advocates expressed disappointment with the bill and have said they aim to take action to rectify the problem before the PHE ends, which could happen as early as July.