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New CMS Guidelines: What Healthcare Providers Need to Know in 2024

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December 20, 2024

 

New CMS Guidelines: What Healthcare Providers Need to Know in 2024

Medicare and Medicaid are necessary for United States healthcare. Organizations must follow CMS regulations to succeed.

These programs set standards that affect the entire system. Providers and insurers must adapt to CMS guidelines.

Now, we'll explain these updates and what providers need to know.

 

What Are CMS Guidelines?

CMS guidelines are vital for healthcare. They cover patient safety, billing, and care.

Medicare & Medicaid Services sets these rules. They guide providers on treatment, record-keeping, and invoicing. The rules are updated regularly to ensure fairness and efficiency.

Facilities must adapt to ensure compliance and quality care. For health specialists nationwide, respecting CMS guidelines is necessary.

 

Overview of the CMS Final Rule for CY 2024

On November 2, 2023, CMS completed policy adjustments. They affect Medicare payments and billing starting January 1, 2024. These updates are part of CMS's initiative for fair-minded, refined health solutions.

CMS wants to make quality care more accessible. So, it will put patients at the center of our practices.

 

Understanding the Physician Fee Schedule (PFS)

The Physician Fee Schedule (PFS) is crucial for Medicare payments. It dictates how healthcare workers are paid for serving Medicare patients.

Since 1992, the PFS has set payment rates for care in doctor's offices, hospitals, and surgery centers. Here are some key points about the PFS:

  • Payments for Each Service: Medicare pays different amounts based on how hard the job is and what it needs.
  • Professional and Technical Parts: Payments are split into two parts. One for the doctor’s work and one for tests or procedures.
  • Location-Based Payments: Medicare adjusts payments depending on the costs in different areas.

 

Key Changes in CY 2024 PFS Rate Setting

In 2024, CMS has reduced the overall payment rates by 1.25% compared to 2023, although some specific services will see increases. Notably:

  • The conversion factor for 2024 will be $32.74, a decrease of $1.15 from 2023’s rate of $33.89.

  • Even with deductions elsewhere, CMS is increasing pay for primary and direct patient care. This move shows primary care's vital role in a healthy healthcare system.

 

New Caregiver Training Services in 2024

Cognitive impairment patients depend on guardians for happiness.

In 2024, the Biden-Harris administration will launch a healthcare initiative. It will allow CMS to fund caregiver education.

Physicians, non-physician practitioners, and therapists will lead this training. They aim to encourage those who support patients.

The target is to upgrade healthcare by giving caregivers essential skills.

 

Addressing Social Determinants of Health (SDOH)

CMS is introducing new reimbursable services to confront SDOH. They aim to face social challenges that affect patient outcomes. These include:

  • Community health integration services

  • SDOH risk assessments during annual wellness checkups, behavioral health visits, and E/M visits

  • Primary illness direction services to help coordinate care for patients with complex conditions

 

What do These Changes mean for Healthcare Providers?

These updates aim to improve care for patients with complex needs. They should make it more personalized.

Healthcare providers must learn and follow the new rules. This is to stay compliant and get the right payments.

These changes will help providers give better care. Patients will have healthier outcomes.

 

Notable 2024 Updates: Telehealth and Behavioral Health Services

CMS has introduced several important updates for telehealth and behavioral health services:

  • Telehealth Services

CMS is expanding telehealth coverage. It includes, for a limited time, health coaching services. It is making SDOH risk assessments permanent on the Medicare Telehealth Services List. CMS is extending some flexibilities for telehealth sites and coverage through December 2024.

  • Behavioral Health Services

CMS is finalizing new policies to improve Medicare coverage. Starting January 1, 2024, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs can charge for their services.

The growth includes Behavioral Health Integration (BHI) and presents new codes. These codes will cover psychotherapy outside offices, like in homes or mobile units. This will make it more accessible for patients.

  • Medicare Coverage for Crisis Services

New HCPCS codes will recognize psychotherapy for crisis services. Non-facility sites will get higher reimbursement rates (150% of the standard fee schedule).

These updates aim to improve access to care in underserved areas. They will connect physical and behavioral health services.

 

Updates for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

CMS is updating support for rural and underserved healthcare:

  • Telehealth services for RHCs and FQHCs will now last until December 2024.

  • MFTs and MHCs can bring their expertise to these facilities.

  • Payment for Remote Therapeutic Monitoring and Community Health Integration will adjust based on actual use.

These changes aim to increase flexibility and address workforce shortages in rural areas.

 

How Extended Health Services (EHS) Support Providers with New Codes and CMS Updates?

At Extended Health Services, we understand medical billing and coding can be complex, especially with CMS updates.

Our team is committed to helping healthcare providers deal with these updates so they can get paid correctly and stay compliant.

Our years of billing experience support practices improve their processes. We ensure they get paid fairly for their services.

Partnering with EHS can help healthcare providers. To make billing and coding easier, we're here for you. Contact us to increase your practice's earnings and reduce stress!

 

Final Thoughts

The new CMS guidelines for 2024 need quick action from healthcare providers. These changes focus on primary care, caregivers, and social health to make care better and easier to access.

Providers must train staff, update policies, and use new technology quickly. By doing this, they can improve how things run, make more money, and take better care of patients.

Taking action now helps make sure everything is in line with the rules, billing runs smoothly, and the healthcare system is stronger.

 

Reference Link

https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule

 

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