By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm
On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect on January 1, 2024.
Physician Fee Schedule Rate Reductions.
The overall payment rates under the 2024 PFS will be reduced by 1.25 percent in 2024. The conversion factor is $32.74, which is a $1.15 decrease from 2023. This is bad news for physicians who continue to suffer reduced payments from Medicare. Physicians’ Medicare reimbursements will fall overall by 3.4 percent under the PFS in 2024.
The Good News! Mental Health Counselors Now Allowed to Bill Medicare
The good news is that the new 2024 final rule now allows marriage and family therapists and mental health counselors, including addiction counselors, to enroll in Medicare and bill the Medicare program.
Telehealth Expansions.
The PFS 2024 final rule expanded telemedicine and established that telehealth providers will be paid the non-facility rate for telehealth services.
Under the new rule, CMS will temporarily add health and well-being coaching services to the Medicare Telehealth Services List in 2024. Social Determinants of Health Risk Assessments will also be permanently added to the Telehealth Services List.
The final rule also expands the types of telehealth practitioners to include occupational therapists, physical therapists, speech-language pathologists, and audiologists.
The final rule allows all diabetes self-management training services via telehealth. It also enables teaching physicians to be present using telecommunications when a resident furnishes telehealth services.
Finally, the rule established that rural health clinics and federally qualified health centers will continue receiving payment for telehealth services.
Outpatient Program Payment Increases.
CMS increased Medicare payments for hospital outpatient departments and ambulatory surgical centers by 3.1 percent in 2024.
Stipulations in the Outpatient Prospective Payment Program final rule require hospitals to display standard charge information that conforms to a CMS template. Hospitals have been required to post the prices of services online since 2021, but compliance could be better.
Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The lawyers of The Health Law Firm routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicare and Medicaid investigations, audits and recovery actions. They also represent them in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge. Attorneys of The Health Law Firm represent health providers in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.
To contact The Health Law Firm, please call (407) 331-6620 or toll free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.
Sources:
“Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule.” CMS.gov Newsroom. (2 November 2023)
“CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-FC).” CMS.gov Newsroom. (2 November 2023)
“CMS issues CY 2024 physician fee schedule final rule.” American Hospital Association. (2 November 2023)
“CMS Issues Physician Fee Schedule Final Rule with Payment Rate Cut.” American Health Law Association Health Law Weekly. (3 November 2023)
HHS Press Office. “CMS Finalizes Physician Payment Rules that Advances Health Equity.” United States Department of Health and Human Services. (2 November 2023)
“Medicare Payments for Hospital Outpatient Services to Increase 3.1% in 2024.” American Health Law Association Health Law Weekly. (3 November 2023)
Pifer, Rebecca. “CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements.” Healthcare Dive. (3 November 2023)
Vaidya, Anuja. “New PFS Rule Includes Telehealth Payment, Address Reporting Wins.” mHealth Intelligence Healthcare Media. (3 November 2023)
About the Authors: Hartley Brooks is a law clerk with The Health Law Firm. G eorge F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
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Copyright © 2024, George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any form in any medium without the express written permission of the copyright holder. The copyright holder reserves the exclusive right to have his name associated with this work.
