The Centers for Medicare & Medicaid Services (CMS) released the final 2022 Medicare Physician Fee Schedule (PFS) last week. It includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2022.

CMS also released the 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. This rule finalizes CY 2022 OPPS and ASC payment rates and policies, including updates to improve transparency and quality reporting.

According to the Medical Group Management Association, key policy changes included in the 2400+ page rule:

• Setting 2022 Medicare payment rates for physician services. For 2022, CMS finalized the proposed Conversion Factor of $33.5848 and $21.0442 for Anesthesia (a decrease of -3.75% and -2.39%, respectively, over final 2021 rates);

• Delaying the payment penalty phase of the Appropriate Use Criteria (AUC) program to Jan. 1, 2023, or the Jan. 1 that follows the end of the COVID-19 public health emergency (PHE), whichever is later;

• Allowing audio-only visits for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes past the COVID-19 PHE if certain conditions are met;

• Delaying enforcement of the Electronic Prescribing for Controlled Substances mandate until Jan. 1, 2023, for prescribers of controlled substances covered under Medicare Part D;

• Extending the CMS Web Interface as a quality reporting option through the 2024 performance year for Medicare Shared Savings Program participants;

• Setting the 2022 MIPS performance threshold at 75 points, and the additional performance threshold for exceptional performance at 89 points; and

• Setting 2023 as the first performance year of the new MIPS Value Pathways (MVPs), with participation options including individual clinicians, single specialty groups, multispecialty groups, subgroups, and APM entities.

The AMA is expected to provide a comprehensive summary of the fee schedule rule in the near future and indicates they will “continue to strongly advocate for Congress to avert this significant cut and extend the 3.75% increase for 2022, as it further compounds the growing financial instability of physician practices due to the severe reduction in revenue caused by the continued COVID-19 PHE.”

Additional information about the final rule can be found in the PFS fact sheet and the QPP fact sheet.

CMS’s media release describing the final rule, “announced actions that will advance its strategic commitment to drive innovation to support health equity and high quality, person-centered care. CMS’ Calendar Year (CY) 2022 Physician Fee Schedule (PFS) final rule will promote greater use of telehealth and other telecommunications technologies for providing behavioral health care services, encourage growth in the diabetes prevention program, and boost payment rates for vaccine administration. The final rule also advances programs to improve the quality of care for people with Medicare by incentivizing clinicians to deliver improved outcomes.”