Proposed Physician Fee Schedule Adjustments CY 2024

The CY 2024 Proposed Rule for the Physician Fee Schedule (PFS) brings updates to payment rates for dermatologists as mandated by law. These proposed changes aim to balance payment adjustments and ensure budget neutrality across various services. It is crucial for healthcare providers to understand the implications of these proposed updates to effectively plan for the future. In this article, we will delve into the key highlights of the proposed rule and its potential impact on providers.

Increased Payments for Visit Services

One notable aspect of the proposed rule is the increase in payment for many visit services. CMS is proposing higher payment rates for these services. However, these proposed increases necessitate offsetting adjustments to maintain budget neutrality across all other services covered under the PFS.

Proposed CY 2024 PFS Conversion Factor

The proposed CY 2024 PFS conversion factor, which determines payment rates for various services, is set at $32.75. This represents a decrease of $1.14, equivalent to 3.34%, compared to the CY 2023 conversion factor. The conversion factor plays a crucial role in calculating reimbursement rates, and its adjustment directly impacts the financial aspects of healthcare providers.

Implications and Considerations

The proposed changes in the CY 2024 PFS rule present both challenges and opportunities for providers. While the overall reduction in payment amounts may pose financial pressures, the potential increase in payment rates for visit services could benefit providers in those areas. It is important that providers carefully analyze the impact of these proposed changes on their specific specialties and practices.

The Comment Period

Understanding the proposed changes and their implications is crucial for healthcare providers to effectively plan for their 2024 budgets and income projections. By actively participating in the comment period and staying informed about updates, providers can advocate for their interests and adapt their strategies to maintain financial stability while delivering quality care.

Your Billing Service’s Role

As healthcare providers navigate the potential impact of the proposed changes in the CY 2024 PFS rule, partnering with a knowledgeable and experienced billing company can provide valuable support. At the Inga Ellzey Billing Companies, we specialize in billing tailored to the unique needs of dermatology practices. Our team of experts is well versed in the intricacies of reimbursement processes, including the evolving regulations and coding requirements. We can help healthcare providers optimize their revenue cycle management, work through complex billing challenges, and ensure accurate and timely reimbursement. By leveraging our expertise, dermatologists can focus on delivering exceptional patient care while maintaining financial stability in the face of reimbursement adjustments.

The Importance of Quality Reports

As you move forward in Fiscal Year 2024, it is vital that your practice monitor its performance. The only method of accomplishing this is by scrutinizing your monthly reports. The most important reports to review are:

1. Aging Report: This reports tells you how much money is outstanding in unpaid claims. The reports breaks this down into dollar amounts and percentages. The columns you need to pay attention to are:

• • Current charges – amount and percentage
  • Monies outstanding over 90 days – amount and percentage

The amount over 90 days should be 10% or lower. Most importantly, know why those dollars have not been paid as most carriers pay claims between 30-45 days while Medicare pays in less than 14 days.

2. Collections: This represents the actual amount collected from both insurance carriers and patients.
3. Adjustments: This represents the dollars (or percentage) that were charged but were written off. It is vital that you evaluate the difference between contractual adjustments versus:

• • Bad debt
  • Carrier denials after reviews/appeals
  • Filing limits exceeded
  • Non-covered services
  • Insurance Only (which is illegal 99% of the time)
  • Other

This monthly reports must be able to provide you with this data as some billing entities, whether in-house or out-sourced, can just write off charges to make the Aging Report look good resulting in significant revenue losses.

Your Fee Schedule

It is vital that you understand your fee schedule(s) in order to assess the quality of your billers. For example, if your fee schedule is 40% above the Medicare fee schedule, then your monthly adjustments should be somewhere in that range. If your adjustments far exceed the 40%, it is important that the practice owners are able to ascertain why. Additionally, if the adjustment ratio vacillates significantly from one month to the next, it is important to know why. Be sure the answer is quantified by your billers.

Another important aspect of understanding your fee schedule is making sure that you charge at least the approved amount by contracted carriers. If you cannot access your contract with the carrier(s), then look at EOMBs (Explanation of Medical Benefits) from the contracted carriers and compare what you charged compared to what the carriers allowed minus any deductibles or co-pays. If you see some services are paid at 100%, then only increase that CPT code. Do not raise the entire fee schedule as this will only inflate your adjustments and give you a false sense of the practice’s productivity.

In Summary

With the new proposed reduction in non-visit services and the ever-increasing challenges trying to get paid by carriers, it is important the practice owners take a proactive approach by evaluating your billing-related processes, whether using outsourced medical billing services or an internal team, to optimize collections by understanding the billing functions and their effect on practice revenues. 

Note: The content of this article is based on the provided information and may be subject to change pending finalization of the CY 2024 PFS rule. It is recommended to monitor official updates and consult with CMS for the most accurate and up-to-date information.

Source:  CMS Physician Payment Rule Advances Health Equity

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