Medicare Update

Congress, under pressure from physician lobbying groups, stepped in to avoid the cuts with the PROTECTING MEDICARE AND AMERICAN FARMERS FROM SEQUESTER CUTS ACT that became law on December 10, 2021. The act helps mitigate a few negative updates for the Medicare Fee Schedule.   

Here is a short update.   

1. The conversion factor update was scheduled to result in a -3.81% update.  The act infused the Medicare program with additional funds to significantly lessen this impact.  The result is a conversion factor of $34.6062 net change of -0.81% from last year. 
2. Sequestration delayed.  The act suspends the full sequestration cuts of 2% through March 31, 2022, and phases the sequestration cut in with a 1% cut from April 1 – June 30, 2022.  The full 2% sequestration adjustment will begin July 1, 2022.  This delay will likely be funded with an increase in the sequestration adjustment in future years, likely to begin in 2023 unless other action is again taken by Congress. 
3. PAYGO suspension.  The PAYGO law would have required an additional 4% reduction in Medicare payments for 2022.  The act suspended this requirement for one year.  Funding was not appropriated and must also be addressed in the future. 
4. The Radiation Oncology and Radiation Therapy Centers demonstration project was delayed until 2023. 
5. Cuts to the Clinical Lab Fee schedule have also been delayed for one year. 

The RVU impact for Urology overall is 0.0%.  The final rule adopted an update to the way clinical lab costs are calculated relative for adjustments in Practice Expense RVUS but allowed a 4-year phase-in of the updated clinical labor rates which will allow practices to be able to adjust to this change.  MS will use the median Bureau of Labor Statistics (BLS) wage data instead of the mean wage data and use the 2021 BLS fringe benefits multiplier of 1.296 as opposed to the 2002 BLS fringe benefits multiplier of 1.366.  These phased-in changes will help mitigate the sudden and significant change to urology practices, or at least in the short run.  Practices will need to evaluate how this affects them both for 2022 and for years to come. 

As noted above the RVU changes for 2022 when adjusted for volume across all Urologists is projected to be 0%.   The global look at RVU changes does not tell the entire story and will not apply equally to all Urologists. 

The codes listed in the Tables below are a sample of fee changes for the biggest changes for next year in the office broken down by increases and decreases and the Facility/HOPD/ASC in the 3^rd table. 

In all the relief, while appreciated by the Medical community, does not adequately address the increased costs of running a medical practice and we are left with a somewhat empty celebration of the changes. Every little bit helps. Of course, lobbying efforts will need to continue as the currently required payback of items 2-5 is slated at this point to begin in 2023. 

We would also like to provide you with a few additional updates and rule changes that need to be addressed in 2022. 

Office Fees Decreasing – Sample

Office fees Increasing -Sample

Facility Fee Sample