On Demand - 2024 Final Medicare Physician Fee Schedule and Hospital Payment Rules Impacts-Presentation Slides

Presentation Slides

Pdf Summary

The 2024 Medicare Physician Fee Schedule and Hospital Payment Rules have been released, and they have several impacts on cardiology. The conversion factor for 2024 has been reduced by 3.37% compared to 2023, which may affect reimbursement for cardiovascular services. The Appropriateness Use Criteria (AUC) program has been paused, and CMS will propose a new approach in the future. The definition of "substantive portion" for Medicare split/shared services has been changed to align with the revised CPT E/M definition. This means that if a physician or QHP performs a substantive portion of the encounter, they can report the service. Telehealth flexibilities have been extended through December 31, 2024, allowing patients to receive telehealth services wherever they are located. The use of audio-only for appropriate services is also allowed. The Medicare Caregiver Training program has been introduced, which allows for individual or group training for unpaid caregivers assisting patients with chronic or other health conditions. Other new services covered include Social Determinants of Health (SDOH) risk assessment, Community Health Integration (CHI) services, and Principal Illness Navigation (PIN) services. The Quality Payment Program (QPP) has introduced new measures and MVPs for heart disease, and the scoring remains the same. The final rule for the Outpatient Prospective Payment System (OPPS) has resulted in a 3.1% increase to payment rates, with changes to cardiac ablation services, supervision of cardiac rehab by NPs, PAs, and CNSs, and the expiration of payment for coronary intravascular lithotripsy. Finally, there are several ongoing advocacy efforts by the American College of Cardiology, including Medicare payment reform, carotid artery stenting, and information blocking disincentives.

Keywords

2024 Medicare Physician Fee Schedule

Hospital Payment Rules

cardiology impacts

conversion factor reduction

reimbursement for cardiovascular services

telehealth flexibilities

Medicare Caregiver Training program

Social Determinants of Health (SDOH) risk assessment

Quality Payment Program (QPP)

Outpatient Prospective Payment System (OPPS)