Overview of the 2022 Physician Fee Schedule Final Rule

Overview of the 2022 Physician Fee Schedule Final Rule

In January, CMS released the overview of the 2022 Physician Fee Schedule final rule. This contains important information about how your care management services will be valued and reimbursed in 2022. The overview is dense – over 1,000 pages. But don’t worry! DocsInk has taken the time to identify key trends and changes that you need to know about. Not only did we make an abridged version….we made an abridged version 🙂

To download DocsInk’s complete 2022 Physician Fee Schedule Final Rule – click here.

In the meantime, here’s short and skinny:

Finalized Conversion Factor

Centers for Medicare and Medicaid Services (CMS) 2022 conversion factor1 has been set at $34.60. 

What does this mean for your care management service? 
It depends on the type of care management service you provide:

Chronic Care Management (CCM): 

  • CMS has adopted the American Medical Association’s (AMA) RVU2 Update Committee’s (RUC) recommendation to increase RVU for CCM services to better reflect the value of time spent providing CCM services. 
  • As a result, the reimbursement for CCM services has increased in 2022.

Remote Physiologic Monitoring (RPM): 

  • There are minimal reimbursement rate adjustments to RPM services based on both slight reductions to RVUs and the conversion factor rate. 
  • Based on the conversion factor listed above, the decline in reimbursement will be marginal compared to 2021 rates. 

 Source for RVU definition: https://www.aapc.com/practice-management/rvus.aspx

Chronic Care Management 

  • CMS added 1 new CCM CPT code, 99437, which is an add-on code to the existing 99491 code. They also updated the requirement of beneficiary consent. 

99437

Chronic care management  services, provided personally by a physician or other qualified healthcare professionals (QHP), each additional 30 minutes per calendar month with the following required elements: 

  1. Multiple (two or more) chronic conditions are expected to last 12 months, or until the death of the patient.
  2. Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
  3. A comprehensive care plan was established.

What is an add-on code?

Since 99437 is classified as an “add-on” code, it may only be billed in conjunction with CPT code 99491, and it follows the same billing requirements as 99491. 

  • One of these requirements is that the care management services must be performed personally by a physician or other qualified healthcare professional (QHP).

This is where a gray area appears in the CMS Final Rule: 

  • In CMS’s final rule, CPT Code 99437 “describes CCM services furnished by clinical staff under the supervision of a physician or NPP who can bill E/M services and CCM services personally furnished by a physician or NPP.”
  • This is in direct contradiction to the AMA’s CPT codebook for the 99437 CPT code, which specifies that the code can only be performed by a physician or QHP3.

So, what should I do? DocsInk recommends that you err on the side of caution, and only bill for 99437 when the care management service is performed by the physician for QPH in order to avoid being audited.

During the Public Health Emergency (PHE) CMS allows beneficiary consent to be obtained by auxiliary staff under general supervision, meaning the staff can be remote from the billing provider4. Previously, CMS required that beneficiary consent be obtained directly from the billing provider or by staff working directly under their supervision. 

Telehealth 

Category 3 Codes 

In 2021, CMS created a list of Category 35 codes to describe the telehealth visits which will be covered temporarily during the COVID-19 PHE. The 2022 Final Rule extends the reimbursement of the Category 3 telehealth codes throughout the last day of 20236, giving CMS time to evaluate which telehealth visit codes meet the requirement for permanent coverage beyond 2023.

Allowances for Geographic Restrictions and Originating Sites 

During the PHE, waivers were granted under section 1135 of the Social Security Act and the CARES Act, giving CMS the authority to waive geographic origination requirements for the duration of the PHE7. To continue these site allowances beyond the PHE, Congress must pass legislation to overturn section 1834(m) of the Social Security Act. 

There is an exception to the geographic restrictions beyond the PHE in regard to the provision of telehealth services in the home of an individual for the treatment, diagnosis, or evaluation of mental health or substance abuse disorder. 

Telemental Health Services

CMS finalized keeping Section 123 of the Consolidated Appropriations Act legislation, which removed geographic restrictions and allowed a patient’s home to be the originating site for telehealth visits when used for the purposes of diagnosis, evaluation, or treatment of a mental health disorder8

Conditions for Medicare reimbursement:

  •  Requires an in-person visit within six months of the initial telehealth service.
  • An in-person visit must be conducted by the provider at least once every twelve months thereafter9.

Audio-Only Mental Health Services

CMS finalized reimbursement for audio-only telehealth services for the treatment of mental health conditions beyond the PHE. 

The following conditions must be met: 

  • The practitioner has the capability to use an interactive telecommunication10 system that includes video. 
  • The beneficiary is incapable of or fails to consent to, the use of video technology 
  • The beneficiary is located at their home at the time the service is delivered11.
  • The practitioner documents the reason for using audio-only technology in the patient’s medical record, and they use the appropriate service level modifier. 

1Conversion Factor (CF): the number which is multiplied by the relative value units (RVUs) assigned to each CPT and HCPCS Level II code, which together determine the annual fee-for-service Medicare reimbursement rates.
2Relative Value Units (RVU): define the value of service or procedure relative to all services and procedures. The measure of value is based on the extent of work required from the physician, clinical and non-clinical resources, and expertise required to deliver the service to the patient.
3 According to the American Medical Association (AMA) CPT Codebook, “Code 99437 is reported in conjunction with 99491 for each additional minimum of 30 minutes of a physician or other qualified health professional time.”
4 The PHE will be extended into 2022, however, at this time it is for an indeterminate amount of time.
5Category 3 codes are a subset of codes that were added during the PHE, however not every temporary code added is considered a Category 3 code. Codes not considered Category 3 codes.
6Codes not considered category 3 will not be considered for reimbursement once the PHE ends.
7Prior to the PHE, in order to be reimbursed for telehealth visits, care had to be provided at an eligible site in a rural area.|
8A hotel, car, etc could be classified as “home” for those who are without homes.
9 There is an exception: if the patient and practitioner consider the burdens of the visit to outweigh the benefits. The practitioner must document this on the patient’s medical record, then the in-person visit is not applicable for 12 months.


Who is DocsInk

DocsInk®, a NC-based healthcare technology company founded in 2012, addresses the fiscal, communication and connectivity needs of medical professionals. Utilizing Software-as-a-Service, DocsInk is revolutionizing the healthcare technology industry. Its simple solutions improve the speed, efficiency, accuracy and options in the delivery of patient care, and our team provides a customer experience second to none. With more than 15,000 users who serve more than one million patients across the United States, DocsInk is among the top healthcare communication companies. Learn more at www.docsink.com.

Finally, a New Approach to Opioid Addiction Treatment

Finally, a New Approach to Opioid Addiction Treatment

Real-time measurable data creates ability to treat the 2.1 million people diagnosed with opioid addiction each year, responsible for 104,000 overdose deaths over the past twelve months.

Statistics show that 1 out of 10 people abuse opioids, costing the U.S. $78.5 billion a year. Multiple government agencies have released guidance policies to fight this rising epidemic, including The Department of Health and Human Services (HHS) who declared a public health emergency in 2017 with a 5-Point Strategy To Combat the Opioid Crisis, and The U.S. Centers for Disease Control and Prevention (CDC) who issued there opioid prescribing guideline. Despite these and other strong efforts, leading healthcare agencies such as the American Medical Association (AMA) continues to emphasize that our nation’s drug-related overdose and death epidemic continues to worsen.

Addiction is a Physiologic Response

With a foundational belief that addiction is a physiologic response rather than a moral failing, OpiAID, a data science company, was created to support clinicians in curbing opioid abuse. Offering instant access to both pre-existing and real-time patient data including biometrics and behavioral insights, OpiAID helps medication-assisted treatment (MAT) centers and clinicians prevent relapses, avoid potential overdoses, and provide successful remedies.

OpiAID’s integrated EHR decision tool effortlessly collects personalized behavioral and health data stored in the cloud, and then with new innovative AI technology, instantly converts this data into vital insights. This leads to actionable treatment interventions and improved clinical decision making, that stops drug seeking behavior, proactively addresses valid medical needs, and saves lives.

“OpiAID isn’t just technology assisted therapy (TAT), it is an assisted therapy.”

Docsink, a leading remote patient monitoring (RPM), telehealth, and secure communication application, has been committed to delivering simple and effective solutions used to improve treatment and access to care for our nation’s most vulnerable patient populations for over 12 years. Their award-winning application has helped thousands of healthcare providers across the nation connect to their patients and provide a link to real-time physiologic and non-physiologic patient data, shown to improve overall patient health outcomes. 

Partnering together, OpiAID and DocsInk have combined their best-of-breed technologies, making an impactful improvement on the fight to solving the opioid crisis creating a new approach to opioid addiction treatment. No longer is patient information siloed, but rather the critical data is gathered and shared instantly so that it becomes actionable, understanding that every second is critical when fighting against drug addiction.  

We encourage you to connect with us to learn more about how you can help us support your patients on their road to recovery. Please visit us at www.docsink.com/OpiAID or call us at 888-577-7409.

Connecting Patients and Care Teams in over 35 Languages

Connecting Patients and Care Teams in over 35 Languages

What is clear is that effective communication between patient
and their care teams, when and where it is needed,
is imperative. 

Healthcare’s continuing journey towards value-based care has highlighted the need for increased patient engagement between patients and their care teams. Over the past 7 years, both governmental and commercial payors have steadily increased their coverage and reimbursement of various virtual care services including chronic care management (CCM) and remote physiologic monitoring (RPM); shown to increase communication with patients between scheduled in-person visits and improve overall health outcomes.  

COVID-19 and the Healthcare Industry

Most recently, the surge of COVID-19 has forced the healthcare industry to re-think how to provide immediate access to medical care. A study by McKinsey shows a sustained usage of telehealth services  38X higher than before the pandemic. Physicians and the patients they serve have pivoted, and telehealth now accounts for between 13% to 17% of all outpatient office visits across all specialties in our nation.

During the rapid growth of telehealth, one systemic downfall became clear: most platforms support only those who speak English. DocsInk quickly realized that we had to eliminate the frequent language barriers that exist while treating and communicating with patients via telehealth, as well as the often-times related CCM and RPM services.

As a result of our work with athena Health, DocsInk is now the first telehealth platform to implement an interpreter feature.

Connecting Patients and Care Teams

The DocsInk platform allows the practitioner to establish immediate and effective communication, by facilitating each patient’s preferred language. Unlike the use of artificial intelligence, a live interpreter makes all the difference when trying to convey complex physiological and psychological concerns. DocsInk’s telehealth platform includes access to live interpreters who speak 38 different languages. This assures that all information is precisely relayed and understood, avoiding costly errors and mistakes which are often caused by barriers in communication between care team members.

DocsInk has gone the extra mile to offer a simple and affordable application unlike any other, by promoting a connected healthcare continuum that ensures every patient and provider can effectively communicate when and where needed, in their own native language.

Communication matters. Choose DocsInk. For more on DocsInk and their services email or call 888-577-7409.

New DocsInk Updates

New DocsInk Updates

DocsInk Updates Released 8.4.2021

DocsInk released an update on the below items:

  • Extension
  • SSO for Integrated EHRs
  • Remote Patient Monitoring and Metric Check In Reviews
  • Transition of Care Management and Patient Qualification Programs
  • Telehealth and EHR Schedule Integration
  • Waiting Room Check In

  • Telehealth
  • Blur Background
  • Charge Capture
  • Picture in Picture
  • Users List
  • Feedback Option
  • Remote Patient Monitoring
  • Device ID Updates
  • Alert Setup on RPM Assignment
  • Bug Fixes
  • Same Name Patient Search Issue on Desktop
  • Charge Capture on Android
  • Gallery Dominant Speaker View

EHR Integrations

  • athenahealth – Fully released in their marketplace
  • Allscripts – Releasing in their marketplace shortly
  • Nextgen – Releasing in their marketplace shortly
  • CareCloud – Releasing in their marketplace shortly
  • Elation – Releasing in their marketplace shortly
  • PointClickCare – Releasing in their marketplace shortly

Please contact your Account Technician for more information.

New DocsInk Updates: Released 8.4.2021

DocsInk has released an update on the following items:

  • Extension
  • SSO for Integrated EHRs
  • Remote Patient Monitoring and Metric Check In Reviews
  • Transition of Care Management and Patient Qualification Programs
  • Telehealth and EHR Schedule Integration
  • Waiting Room Check In
  • Telehealth
  • Blur Background
  • Charge Capture
  • Picture in Picture
  • Users List
  • Feedback Option
  • Remote Patient Monitoring
  • Device ID Updates
  • Alert Setup on RPM Assignment
  • Bug Fixes
  • Bug Fixes
  • Same Name Patient Search Issue on Desktop
  • Charge Capture on Android
  • Gallery Dominant Speaker View
  • EHR Integrations
  • athenahealth – Fully released in their marketplace
  • Allscripts – Releasing in their marketplace shortly
  • Nextgen – Releasing in their marketplace shortly
  • CareCloud – Releasing in their marketplace shortly
  • Elation – Releasing in their marketplace shortly
  • PointClickCare – Releasing in their marketplace shortly

Please contact your Account Technician for more information