The Centers for Medicare and Medicaid Services (CMS) set the 2024 Medicare Physician Fee Schedule with a reduction in the conversion factor. This affects how much doctors get paid across the country. Starting January 1, 2024, the conversion factor dropped by about 3.37%, going from $33.8872 in 2023 to $32.7442. This means many providers, including those offering pulmonary and cardiac rehab, will see lower payment margins.
Even with this drop, CMS expects payments for cardiovascular services, closely linked to pulmonary rehab, to stay mostly steady compared to 2023. This is partly because of changes tied to a new billing code and more options for supervision.
In 2024, advanced practice practitioners (APPs) like nurse practitioners (NPs) and physician assistants (PAs) are now allowed to supervise pulmonary rehabilitation programs according to CMS rules. This change started January 1, 2024, thanks to the Improving Access to Cardiac and Pulmonary Rehabilitation Act.
Before, mainly doctors could supervise these rehab programs. This limited providers, especially in rural or underserved areas where APPs often are the main care providers. Letting APPs take this role can help more patients get access and may lower waiting times for care.
CMS began using a new billing code called G2211 in 2024. This code covers the extra work and time needed for managing patients with long-term and complex conditions, like those in pulmonary rehab.
Introducing G2211 affects Medicare’s budget rules, which keep overall spending balanced. While payments go up for visits with this add-on code, the drop in the conversion factor balances some of the increase. For billing teams, this means they must use the G2211 code correctly and keep good records to get paid fairly.
The code shows the complexity and time spent beyond regular visits. Training staff and providers on this is important to avoid claim denials and make sure the care provided is paid for properly.
The COVID-19 emergency led to bigger telehealth rules, especially for pulmonary rehab. CMS extended these rules, such as letting patients get telehealth care from home or other places outside clinics, with payments for video and audio visits through December 31, 2024.
Telephone evaluation codes (99441–99443 and 98966–98968) are also covered in 2024. These help patients get care without going in person, which is important for people with breathing problems.
However, CMS said these telehealth expansions are temporary. Pulmonary rehab may not stay on Medicare’s Telehealth Services List after 2024. Providers should plan for changes and possible ending of these rules.
Split/shared billing lets doctors and non-doctors share billing for evaluation and management services. CMS proposed new rules for this in past years.
For 2024, CMS delayed these new rules. The pause lasts at least until December 31, 2024. This lets healthcare groups keep their current billing methods for now.
CMS also paused a program called Appropriate Use Criteria (AUC), which looks at certain pulmonary procedures. This delay gives facilities more time to get ready.
CMS updated the Quality Payment Program (QPP) for 2024. This includes the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), which make reporting easier and tie quality measures to areas like pulmonary rehab.
The MIPS performance score needed to avoid penalties stays at 75 points in 2024. This threshold keeps the same incentives for providers in value-based care.
CMS added 14 new quality measures, removed 12, and partly removed 3 others. This shows they are changing how quality is measured.
Providers doing pulmonary rehab should watch these changes carefully. MIPS scores can affect money paid and public reports about provider performance.
As Medicare billing and supervision rules change, medical administrators and IT managers need ways to manage complex work and follow rules. Artificial intelligence (AI) and automation tools can help with this.
Using these technologies helps healthcare groups adjust without big manual changes. This can be very helpful for busy pulmonary rehab programs handling many patients and complex care.
Pulmonary rehab is important for patients with chronic lung diseases like COPD, asthma, and pulmonary fibrosis. Since many people have these conditions in the U.S., even small payment changes affect many providers.
Allowing APP supervision increases capacity in places with few doctors. This may improve patient access and reduce waiting lists.
The G2211 add-on code shows CMS knows managing pulmonary patients is often complex. These patients often have several health problems and need more time and resources. Using this code correctly may help offset some payment cuts from the conversion factor drop.
Telehealth flexibilities keep services accessible but are temporary. Providers should tell patients this and get ready for possible changes after 2024 to avoid care disruptions.
Quality reporting tied to pulmonary rehab will increasingly affect payments. Providers need to track MIPS participation and make sure clinical care fits CMS measures to stay financially stable.
Healthcare groups providing pulmonary rehabilitation in the U.S. need to make changes in billing, supervision, and technology use to keep up with these updates. Doing this helps them keep steady payments, offer quality patient care, and meet legal requirements for 2024 and the years ahead.
The ATS Coding & Billing Quarterly is a newsletter summarizing key information on coding, billing, documentation, and regulation policy changes related to respiratory, critical care, and sleep medicine, aimed at ATS members practicing in the U.S.
Topics include new CPT and ICD-10-CM codes, changes in coding nomenclature, regulatory policies, and Medicare coverage specific to pulmonary patients.
The ATS Coding & Billing Quarterly is published quarterly, providing timely updates and information.
G2211 is an add-on code introduced for evaluation and management (E/M) services to reflect increased complexity and time spent during patient consultations.
The December 2023 issue discussed telehealth extension for controlled substances, updates on the Medicare conversion factor, and various coding questions.
The 2024 Medicare Physician Fee Schedule included updates on G2211 coding, new billing practices, and changes affecting pulmonary rehabilitation supervision.
Best practices include thorough documentation of procedures, patient interactions, and compliance with coding standards to ensure proper reimbursement.
Topics often include coding for sleep apnea, critical care services, E/M documentation, and specific pulmonary procedures such as bronchoscopic codes.
Coding guidance for COVID-19 has evolved, particularly regarding telehealth services, public health emergency responses, and specific documentation requirements.
ATS provides resources like the Coding and Billing Quarterly newsletter, toolkits for pulmonary rehabilitation reimbursement, and FAQs on billing procedures.
Simbo is using AI agents to automate all phone related workflows. Connect now to know more.
Schedule AI Agents Demo Now© Since 2019, Simbo AI.
