How Are You Doing With The 2023 MPFS Updates?

by  Find-A-Code™
Jul 3rd, 2023

Every year, the Centers for Medicare and Medicaid (CMS) updates its Medicare Physicians Fee Schedule (MPFS) with a final rule that is normally published near the end of the year and effective the following year. This year is no exception. Updates for 2023 were implemented on January 1.

Though none of the updates for 2023 are necessarily drastic, they will affect medical coding, medical billing, and healthcare provider reimbursement for the entire year. By this time, most coders and billers should be comfortable with the 2023 MPFS final rule.

More About the MPFS

The MPFS is a payment system established by CMS to reimburse healthcare providers for services provided to Medicare subscribers. It was first established by the Balanced Budget Act of 1997. Annual updates ensure that the system keeps pace with the healthcare industry.

Under the MPFS, covered services are assigned a relative value unit (RVU). Units are supposed to account for the time and resources required to provide a given service, thereby providing a basis for billing. Note that RVUs are adjusted for a number of variations, including geographic location.

A conversion factor is applied to RVUs to determine the reimbursement amount a facility or clinician receives for each billed service. It is represented as a dollar amount applied to each unit. This is where most of the annual updates take place. CMS updates conversion factors based on economic conditions, regulatory updates, etc.

5 Biggest Changes for 2023

For 2023, there are five changes deemed significant by CMS. They relate to coding, documentation, and reimbursement surrounding evaluation and management (E/M) visits.

In brief, here are the five changes:

1. New descriptor times have been implemented.
2. Interpretive guidelines for decision-making have been revised.
3. Coders can now choose between time spent or medical decision-making.
4. 3 new G-codes replace CPT codes 99356 and 99357.
5. History and physical exam have been replaced by medic the appropriate history and physical exam, for coding purposes.

Having the choice between time spent and medical decision-making should make coding certain E/M visits easier, at least in theory. But if clinicians and coders are not familiar with the 2023 final rule, mistakes can be made.

Still a Difficult System

One of the challenges of the MPFS is that it can be complex and difficult to understand. The system relies on a large number of codes and calculations which can be overwhelming to providers who are not familiar with the system. Despite annual attempts to improve the system and make it easier, it remains as difficult as ever.

Clinicians, coders, and billers can take advantage of free CMS resources designed to help them navigate the MPFS. Resources include educational materials, webinars, etc. intended to make it easier to understand system requirements. As the thinking goes, a good understanding ensures that healthcare providers are billing appropriately for services provided.

It is Not Going Away

The MPFS plays a key role in ensuring that healthcare providers are appropriately reimbursed for services they provide to Medicare subscribers. According to CMS, the system is designed to encourage quality and efficiency in healthcare delivery, while also incentivizing providers who participate in alternative payment models to meet the same quality standards.

Even though the system can seem unnecessarily complex at times, it is not going away. It was established by federal law and will remain the primary guideline for determining how providers are reimbursed for E/M services. It's up to the facilities, clinicians, coders, and billers to be familiar with how the system works. As always, using the right codes is critical to ensuring full and timely reimbursement.