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5 Top Medical Billing Changes in 2022

medical billing changes 2022

If you’ve been following our blog or reading the monthly newsletter, you already know that some significant medical billing changes are coming in the new year. These medical billing changes will impact how your practice gets paid. Before we dive into the significant medical billing changes coming in 2022, here’s a summary of the important medical billing changes we saw in 2021.

  • One of the fundamental changes was the revision of office visits and evaluation and management rules, also known as E/M guidelines. History and physical exam were eliminated as elements for code selection. Physicians instead were asked to document patient consults basis the level of MDM (medical decision making) or total time one date of service. Read the revised CMS E/M 2021 Guidelines.
  • There were 329 CPT code revisions (206 new CPT codes, 54 code deletions, and 69 cover visions).
  • The CDC also created codes and medical billing guidelines for COVID-19.
  • Medicare approved the telehealth reimbursement of audio-only calls for mental health visits conducted by rural health clinics and federally qualified health centers.
  • The Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline is December 31, 2021. Contact for assistance with the MIPS application submission.

Medical Billing Changes in 2022 – Here’s What’s Coming

1. No Surprises Act Comes into Effect on January 01, 2022: The No Surprises Act comes into effect from January 01, 2022. 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). Learn more about how the No Surprises Act 2022 will impact medical practices.

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. 

PracticeForces has been serving U.S. physicians across specialties since 2003. We invite you for a complementary revenue review session to assess what you can do differently in 2022 to boost your medical practice revenues. Make a promising start to 2022 by booking your session today. Email questions@practiceforces.com or fill the contact us form.

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