Federal Update: Physcian Fee Schedule Final Rule Released

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2023 Medicare Physician Fee Schedule (MPFS) final rule which updates payment rates and other PFS policies, including those to the Quality Payment Program (QPP). 

Of note, the final CY 2023 (MPFS) conversion factor is set at $33.0607, which is down approximately 4.47%, or $1.55, from CY 2022. The reduction is the result of CMS’ finalized policies, including the statutory payment update of 0.00% and the impact of budget neutrality (-1.60%), as well as the expiration of the temporary, one-time payment increase of 3.0% provided under the Protecting Medicare and American Farmers from Sequester Cuts Act. For rheumatologists, the impact of CMS’ policies is approximately -2%. This figure does not include the impact of the aforementioned expiring temporary payment adjustment (3.0%).

In terms of the value of neuromuscular ultrasound, CMS modified the relative values based on comments from the rheumatology community (see table below). However, CMS erroneously deemed CPT codes 76881 and 76882 as “global” services, eliminating their professional and technical components (PC and TC, respectively). 

CSRO communicated its concerns to CMS staff and urged the agency to quickly correct their files so MACs can pay for these services when the PC and TC are submitted. We will keep you updated on the rheumatology community’s progress.

In this rule, CMS also finalized parts of its proposed implementation of section 90004 of the Infrastructure Investment and Jobs Act, which requires manufacturers to provide a refund to CMS for discarded amounts from certain single-dose container or single-use package drugs. As rheumatology practices know, CMS has required reporting of the JW modifier on their Part B drug claims to indicate discarded amounts. Now, CMS will also require reporting of a new JZ modifier if there were no discarded amounts. In the final rule, CMS creates a transition period: the new JZ modifier will be effective January 1, 2023 but not required until July 1, 2023.

Specific to the Merit-based Incentive Payment System (MIPS), CMS finalized minor changes to the new Advancing Rheumatology Patient Care MIPS Value Pathway, as proposed, but failed to incorporate additional improvement activities as CSRO requested. CMS continues to state they will consider these in the future, and we will keep you updated of any further changes.

Utilization Management Survey: 5 Days Left to Share Your Feedback

There is still time to provide your feedback on the impact of utilization management practices through the Alliance of Specialty Medicine (ASM) survey.

Currently, rheumatology represents 13% of all respondents, and, as a long-time member of the ASM, CSRO requests your voluntary participation to ensure our community's perspective is represented. Survey responses are important: they will be used to illustrate the magnitude of this issue in our federal advocacy work.

The survey closes next week Wednesday, November 16 - we appreciate your consideration!

CSRO Career Center: Tool for Employers Seeking Candidates in Rheumatology

CSRO's Career Center is a great tool for any healthcare provider seeking candidates in the rheumatology community. Devoted exclusively to rheumatology, employers are able to easily post positions for a minimal fee and candidates can then browse all postings for free.

Looking to market your position to fellows-in-training or early-career rheumatologists? Our Career Center will be shared with hundreds of potential candidates around the nation as part of CSRO's Fellows Conference - an annual event curated specifically for rheumatology fellows or rheumatologists just starting their careers. Check out CSRO's Career Center today!

2023-2024 Grant Cycle: Arthritis National Research Foundation (ANRF)

The ANRF is looking for early-career investigators, focusing on areas such as Rheumatoid Arthritis, Osteoarthritis, Pediatric Rheumatology, Juvenile Arthritis, Lupus, Psoriatic Arthritis, Gout, Ankylosing Spondylitis, Scleroderma, Fibromyalgia, Uveitis, and other related Rheumatic diseases to apply for a research grant. Applications are due by January 20, 2023 – more information available here.

November 29 Webinar: Value-Based Care

Designed for both physicians and staff, join the National Organization of Rheumatology Management (NORM) on November 29 for a webinar to review and analyze value-based contracting. Registration available here.

November 30 Roundtable: Patient & Provider Perspectives on Biosimilars Uptake

Join the Arthritis Foundation, American College of Rheumatology, National Psoriasis Foundation, and American Academy of Dermatology Association for a roundtable on November 30 to discuss patient and provider insights into best practices for patient-centered biosimilar adoption. Registration is required – learn more and sign up here.

Mark Your Calendar: CSRO's 2023 Events

CSRO's Fellows Conference: March 10-11, 2023

Help rheumatology fellows as they prepare for their future roles as physicians by encouraging them to attend CSRO's 2023 Fellows Conference – an annual event curated by rheumatologists specifically for rheumatology fellows.

CSRO's Advocacy Conference: September 15-17, 2023

Mark your calendars to join us in Austin for CSRO's Advocacy Conference and celebration of our 20th Anniversary! 

Find all of CSRO's event dates by visiting our Upcoming Events page.

What's Happening in the States

CSRO tracks legislative activity relevant to the rheumatology community and their patients – click here to view a full status report.

Be sure to check out our interactive legislative map tool for additional information about current policy in your state.

MASSACHUSETTS

Step Therapy:

• H.4929: Signed into law

PENNSYLVANIA

Step Therapy & Prior Authorization:

• SB 225: Signed into law

• Payer Issues Reporting Form
• Request assistance with any payer relation issues that may be impacting your patients or office.
• Legislative Map Tool
• Find your state on our interactive map tool to learn about current or proposed policy and ways you can take action to make an impact.
• Action Center
• Use CSRO's Voter-Voice engagement platform to easily communicate and engage directly with your elected officials.
• Policy Correspondence Archive
• Easily access all of CSRO’s policy letters submitted to payers, state, and federal governments as an informational resource.
• Career Center
• Locate the perfect fit whether you're looking for new career opportunities or trying to find the right candidate.

Founded in 2003, CSRO is a 501c3 nonprofit organization dedicated to improving patient access to care nationwide - donate today.