The final “2023 Omnibus Bill” which is the spending bill passed by Congress and signed by President Biden at the end of 2022, provides partial relief from the scheduled Medicare Physician Fee Schedule Conversion Factor cuts.
As previously reported, the changes to the Medicare Physician Schedule Conversion Factor would have reduced physician reimbursement by 4.5%.
Pursuant to the Omnibus spending bill, that reduction in 2023 will only be 2%, but it is nevertheless a reduction.
Both the federal government and the Pennsylvania state government are taking steps to reform the prior authorization process. Take a look at the Pennsylvania Insurance Department press release that was issued November 3, 2022, touting the passage and signing of Pennsylvania Act 146, which is described as creating a new and more effective process for prior authorization review.
Pennsylvania Act 146 is not intended to take effect until January 1, 2024, so there should be adequate time to review and implement the 50 page statute.
Along a similar vein, CMS (Centers for Medicare and Medicaid Services) has proposed to expand access to health information and improve the prior authorization process.
Here is the CMS press release announcing that effort along with the CMS Fact Sheet describing the process.
Note that the process is a continuation of a rule that was first introduced in December of 2020. A revised proposed rule has been issued. Comments are due by March 13, 2023. Additional information is available on the CMS website.
Please click the link to view the Medicare Physician Fee Schedule Final Rule Summary for 2023.
The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”. The alert is based upon OIG’s perception that these Telemedicine Companies are engaged in schemes to pay kickbacks to practitioners to generate fraudulent orders for medical services, specifically:
The Alert states that “telemedicine companies have used kickbacks to aggressively recruit and reward practitioners to prescribe items or services for”:
The Alert goes on to identify common characteristics of fraudulent telemedicine company schemes, i.e.
The Alert also footnotes a list of prior alerts, prior investigations, and prior prosecutions.
On July 7, 2022, CMS released its proposed Medicare Physician Fee Schedule for 2023, which proposes physician fee schedule reductions via the Medicare Conversion Factor.
The link is attached here.
Mike Cassidy recently wrote an article entitled, “Private Equity Deals Offer Both Potential Significant Return and Significant Challenges” in the Legal Summary section of the July 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to read the article which offers useful information for physicians to be cautious about when considering private equity acquisition.
For more information on this, contact Mike Cassidy at mcassidy@tuckerlaw.com, (412) 594-5515
Jeremy Farrell and Rebecca Moran recently wrote an article entitled, “Pregnancy-Related Protections for New Physicians” in the Legal Summary section of the June 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to read the article regarding Pregnancy-Related Protections for New Physicians.
| Jeremy V. Farrell | jfarrell@tuckerlaw.com | (412) 594-3938 |
| Rebecca A. Moran | rmoran@tuckerlaw.com | (412) 594-3941 |
Attached is the link to the new CMS webpage “Ending Surprise Medical Bills”.
The Cyber Incident Reporting for Critical Infrastructure Act (CIRCIA), was passed as part of the consolidated Budget Act for 2022, which also included the telehealth provisions I posted about last week.
The definition of “covered entity” in the Act is far greater than covered entity as defined by HIPAA. Covered entity as per CIRCIA includes all of the entities identified by presidential policy directives as “designated critical infrastructure sector” entities.
However, the recent Medicare Compliance Reporter indicates that this will require hospitals to report cyber breaches in 72 hours and ransom payments within 24 hours to DHS.
The legislation gives the Cybersecurity and Infrastructure Security Agency (CISA) at DHS 24 months to propose implementing regulations, which then must be finalized 18 months thereafter, so we are looking at a window of approximately 3 and a half years at this point.
HHS sent notices to noncompliant physicians and facilities on March 10, 2022 giving them 30 days to return funds paid to healthcare providers who have not complied with the agency’s reporting requirements. Attach is the PDF from HRSA (Health Resources and Services Administration), which is the agency responsible for dispensing and collecting the grant money.
