Congressional Omnibus Spending Deal Eases but Does Not Eliminate, Cuts to Medicare Physician Fee Schedule Scheduled to Begin January 1st

 Chiropractors and Other Providers to Face 2% Cut in 2023, Additional Decrease in 2024

In a Nutshell… Passage of the Omnibus Spending Bill Would:

Reduce the 4.5% cut to the Medicare conversion factor scheduled for January 1, 2023, to 2%

  • Provide for a two-year postponement of the 4% PAYGO sequester cut triggered by the passage of 2021’s American Rescue Plan Act

Early Tuesday morning, congressional leadership unveiled a $1.7 trillion year-end spending bill, with the intention to pass the legislation later this week, as government funding is set to expire on December 23rd. The bill would keep the government funded through the end of September 2023. It passed an important procedural hurdle in the Senate last night, putting it on track to pass both chambers of Congress as expected.

This omnibus spending bill addresses the pending 4.5% cut to the Medicare Physician Fee Schedule scheduled to begin January 1st. Unfortunately, the bill does not eliminate this cut entirely. Instead, rates will be cut by 2% in 2023, with additional cuts scheduled for 2024 (without additional congressional action sometime in 2023).

There is good news, however, as the bill also includes a two-year postponement of the 4% PAYGO sequester cut, triggered by the passage of the American Rescue Plan Act, which was also scheduled for 2023.

Even this 2% cut will threaten Medicare beneficiaries’ access to chiropractic care due to the increased financial instability of chiropractic practices across the nation. Payment cuts from previous years and two decades of essentially flat payment rates, added to high inflation and the lack of adequate annual inflation-based physician payment updates like those applied to other providers (hospitals, long-term care facilities, etc.), can challenge the financial viability of even the strongest practices, potentially creating a crisis in patient access throughout the Medicare system.

What’s Next?
If the bill passes as expected, WPS Medicare will have to re-configure the fee schedule, previously released in November. It is possible that Medicare may not have enough time to release a new fee schedule based on these changes prior to January 1, 2023. As a result, here are some considerations for doctors billing Medicare.

If you are a participating provider of Medicare, continue to bill Medicare at your regular fees. Your bills will be processed based on the appropriate fee schedule once it is finalized. This is the recommendation even after the adjusted fee schedule is released.

If you are NOT a participating provider for Medicare, wait to submit your bills until the fee schedule is finalized. However, you may be able to process your claims using the currently published 2023 rates and inform your patients that additional amounts may be owed or require refunding. Billing based on the 2022 fee schedule is not recommended, as it would potentially result in collected amounts exceeding the statutory Limiting Charge.

Stay tuned for updates to the 2023 Medicare Physician Fee Schedule as they become available.



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