Regulations are used to safeguard and enhance the lives of businesses, individuals as well as the environment, and to help boost economic growth. In order to fully protect everyone’s interest within certain organization, regulations must be updated from time to time if there’s a need. Medical billing may indirectly impact the healthcare industry, but it is important to maintain order and organization in the industry.
To become an effective biller, one must understand the different billing regulations, private and public insurance plan policies. Here are new billing regulations for 2022 every biller as well as customers must be aware of.
1. No Surprises Act Comes into Effect on January 01, 2022
Beginning January 1, 2022, midwives and other health care providers will be required by law to give uninsured and self-pay patients a good faith estimate of costs for services that they offer, when scheduling care or when the patient requests an estimate.
This new requirement was finalized in regulations issued October 7, 2021. The regulations implement part of the “No Surprises Act,” enacted in December 2020 as part of a broad package of COVID- and spending-related legislation. The act aims to reduce the likelihood that patients may receive a “surprise” medical bill by requiring that providers inform patients of an expected charge for a service before the service is provided. The government will also soon issue regulations requiring midwives and other healthcare professionals to give good faith estimates to commercial or government insurers, when the patient has insurance and plans to use it.
Midwives working in group practices or larger organizational settings and facilities will likely receive direction from their compliance department or lawyers on how to satisfy this new requirement.
Its implementation means that patients can no longer be held accountable for emergency services from out-of-network providers or out-of-network hospital services (including ambulance services and emergency room physicians). It also implies that patients should not be liable for ‘balance billing’ by an in-network healthcare facility for services received from out-of-network providers (such as radiologists, anesthesiologists, pathologists, or neonatologists).
2. CMS Announces Lower Medicare PFS conversion factor
The CY 2022 conversion factor will be $33.59, a decrease of $1.30 over the CY 2021 conversion factor. But it’s not just this cut that will impact medical practice revenues in 2022. It’s estimated that the combined effect of the PFS cuts since 2021, as well as the 4 percent Statutory Pay-As-You-Go (PAYGO) cut and the 2 percent cut for Medicare sequestration, will lower medical practice revenues by 10 percent.
3. Modifications in POS codes for Telehealth
The point of service (POS) codes for telehealth will see two main changes. POS 02 has been revised for cases when the telehealth consult occurs outside the patient’s home. POS 10 has been introduced to cover telehealth consults while the patient is home.
4. Split (or Shared) E/M Visits
CMS has stipulated that in 2022 the provider who handles the substantial portion of the visit (which could be on any of the three components – the time spent on history, exam, or medical decision making), or more than half of the total time spent, would bill for the visit.
5. Direct Billing of Physician Assistant (PA) Services
Beginning January 01, 2022, PAs can bill Medicare directly for their services and reassign payment for their services. Currently, payments for services delivered by PAs are made by Medicare to their employers.
These are just a handful of medical coding and billing changes you can expect in the coming year. Keeping track of these changes and training your staff will be crucial to ensuring that your medical practice revenues don’t dip in 2022. If you’re wondering how you’ll stay on top of these medical billing changes in your medical practice, now is an excellent time to partner with an experienced medical billing service.
American Psychological Association. (2021, December 10). New billing disclosure requirements take effect in 2022. https://www.apaservices.org. Retrieved September 27, 2022, from https://www.apaservices.org/practice/legal/managed/billing-disclosure-requirements
Blog, P. F. (2021, December 27). 5 top medical billing changes in 2022. Medical billing and collections as low as 1.99%. Retrieved September 27, 2022, from https://practiceforces.com/blog/medical-billing-changes-in-2022/