Healthcare mandates change fast, especially during a pandemic. As the coronavirus public health emergency draws to a close, your practice can expect changes to Medicare and Medicaid data collection, interoperability, and payment rule. Many Medicare policies were relaxed between 2020 and 2022, and regulations for 2023 reflect a return to business as usual.
Here are four healthcare mandates for 2023 that your practice needs to know about.
The Information Blocking Rule, part of the 21st Century Cures Act, went into effect in 2021. The rule prevents physicians, practices, and other health entities from blocking reasonable access to electronic health information. In 2021, the definition of electronic health information was narrowed to allow practices time to respond to the rule. However, on October 6, 2022, the definition of electronic health information expanded to any information covered under HIPAA. If your practice is not ready to fully comply with the Information Blocking Rule, that should be a top priority for 2023.
Also, by December 31, 2022, all EHR vendors must have adequate data-sharing API capabilities and fully comply with the Information Blocking Rule. You may need to update your practice's EHR system in early 2023 to take advantage of new data-sharing and interoperability features.
Healthcare Mandates For Promoting Interoperability
The 2023 Medicare Inpatient Prospective Payment System (IPPS) Final Rule sets interoperability expectations for hospitals and acute care in 2023. While these rules do not directly apply to practices and ambulatory clinics, they affect how information about your patients' hospital stays is shared with your practice. They may also signal future healthcare mandates with Meaningful Use measures in MIPS.
Through the Promoting Interoperability program, the 2023 IPPS Rule rewards hospitals that use the Trusted Exchange Framework and Common Agreement to share data. By incentivizing hospitals to use this common framework, CMS is helping simplify data sharing and reduce the administrative burdens of interoperability. Your practice can also adopt the framework to ease data sharing with hospitals, specialists, and other healthcare providers.
The IPPS Rule also encourages hospitals to use social determinants of health screening tools to capture data on social needs in a standardized, reportable way. These screening tools can be built into EHRs to ensure complete data for all providers. Ambulatory practices can use a similar approach to gather and share data on social determinants of health to help your patients access the services they need.
Medicare Physician Fee Schedule Changes
The Centers for Medicare and Medicaid Services (CMS) finalized the 2023 Medicare Physician Fee Schedule on November 1, 2022. It includes several updates to payments, coding, and telehealth services relevant to ambulatory clinics.
The Medicare conversion factor, a key factor in Medicare payment, will fall from $34.64 in 2022 to $33.06 in 2023. The 3 percent supplemental increase in reimbursements from 2022 has expired, resulting in the payment decrease.
On coding, CMS is finalizing changes to E&M CPT codes to reduce administrative burdens. These changes primarily affect CPT codes for "Other E&M." CMS also added two new HCPCS codes for managing and treating chronic pain to Medicare coverage. The new codes pay for typical chronic pain management and treatment activities over a one-month period.
The 2023 Physician Fee Schedule Final Rule also extended telehealth flexibilities originally granted in response to the coronavirus pandemic. For at least 151 days after the public health emergency ends, Medicare will still cover telehealth services as it has throughout the pandemic. CMS is studying whether to expand telehealth services permanently and will gather data throughout 2023 to determine how these services will be covered in 2024.
Medicare Quality Payment Program Changes
CMS finalized changes to the Medicare Quality Payment Programs, including MIPS, on November 1, 2022. These changes include adjusting quality measures, introducing the MIPS Value Pathways, and eliminating the exceptional performance bonus.
For 2023, MIPS will consist of 198 measures, of which nine are new and 76 are substantially revised. Additionally, health equity measures will now be considered high-priority. As in prior years, physicians and practices must receive a score of 75 or higher to avoid penalties. If your practice participates in MIPS, review the new measures carefully when selecting what to report for 2023.
CMS also unveiled the MIPS Value Pathways (MVP), an alternative MIPS reporting option for 2023. MVPs are a subset of measures practices can use to reduce reporting burdens substantially. Practices using MVP will be able to report 12 measures instead of other MIPS reporting requirements and remain eligible for performance bonuses.
TempDev Can Help With 2023 Healthcare Mandates
TempDev's consultants can help your practice stay on top of regulatory changes. Whether you need to update your EHR system or revise your policies and practices, TempDev is here to support you. Our NextGen developers, consultants, trainers, and medical billers have the expertise you need to comply with interoperability requirements and maximize your Medicare revenue.
Call us at 888.TEMP.DEV or contact us to learn how 2023 healthcare changes might affect your practice.
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