CMS Releases 2025 Proposed Rules for Physician and Hospital Payment Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule on Medicare physician payment and other Medicare Part B services. While the ATS is still reviewing the proposed rule there are some important key points to share with the ATS membership.
Conversion Factor
CMS is proposing a 2025 Medicare conversion factor of $32.36. This amounts to a cut of $0.93 (or 2.80%) from the current CY 2024 conversion factor of $33.29. The formula for setting the conversion factor is set by Congress and CMS has very little regulatory flexibility to change the established formula . For the past several years, the Congressional formula establishing the conversion factor has resulted in cuts to Medicare physician payment. In some years, Congress has taken action to either prevent the annual cut or reduce the size of the cut, but Congress has not yet seriously considered legislation that would fix the underlying flawed law that established the annual Medicare conversion factor.
Caregiver Training Services
CMS has previously created new codes for physicians and other providers to train family and other caregivers on treating Medicare beneficiaries at home. Covered training included: techniques to prevent decubitus ulcer formation, wound dressing changes, infection control, special diet preparation, and medication administration. CMS is proposing to allow these trainings to be offered virtually in 2025.
Telehealth Provisions
CMS is proposing to maintain telehealth services under Part B and further expand the list of services for telehealth coverage.
ATS coding and billing experts are still reviewing the proposed rule – which is several hundred pages long – and will provide a more complete review in the next edition of the ATS Coding and Billing Quarterly.
TOBACCO CONTROL
U.S. Supreme Court to Hear Case on E-cigarettes
The U.S. Supreme Court announced that it will hear a case next session regarding the Food and Drug Administration’s regulation of e-cigarettes. In the case of FDA v. Wages and White Lion Investments, LLC, d/b/a Triton Distribution, the court has agreed to review a decision by the Fifth District Court of Appeals that overturned the FDA’s marketing denial order on several flavored e-cigarette products. The tobacco industry has challenged the FDA’s marketing denial orders in several different appeals courts and, to date, seven appeals courts have affirmed the agency’s marketing denial order and the Fifth District Court of Appeals has overturned the FDA’s decision. If left uncontested, the Fifth District Court decision would result in a large loophole for companies to make and sell candy-flavored e-cigarette products clearly intended to appeal to underage smokers.
OCCUPATIONAL HEALTH
OSHA Proposes Heat Standard for Workers
Earlier this month, the Occupational Safety and Health Administration issued a long-awaited proposed rule to protect outdoor and indoor workers from dangerous heat. The proposed rule would create a federal standard to protect workers from exposure to dangerous levels of heat and require employers to develop heat exposure protection plans, monitor heat at the workplace, implement cooling measure to protect workers from heath and engage in worker-training activities on preventing heat-related injuries.
While the proposed rule has been released for public review, it has yet to be officially published in the federal record. The proposed rule is expected to have a 120-day public comment period and several public hearings.
