New Medicare billing rules

Over 18% of the U.S. population is covered by Medicare. As of October 2021, the total Medicare enrollment was 63,964,675. Original Medicare enrollment was 36,045,321, and Medicare Advantage and Other Health Plan enrollment was 27,919,354. Medicare accounts for a significant portion of federal spending. In fiscal year 2022, the Medicare program cost $767 billion — about 13 percent of total federal government spending.

Anything that affects Medicare billing has Macroeconomic importance.

The Centers for Medicare & Medicaid Services has issued the final rule for the 2023 Medicare Physician Fee Schedule; it includes a 4.5% fee-for-service reimbursement cut.

The fee-for-service reimbursement cut will make doctors more reluctant to accept Medicare patients. Rural and nonprofit hospitals could be threatened.

As patients, we need to scrutinize our bills since billing professionals will add services to visits to increase reimbursements.

We also need to read the new rules carefully since they will apply to the services Medicare will reimburse.

The Medicare Part B vaccine benefit includes the influenza, pneumococcal, hepatitis B, and COVID-19 vaccine and their administration. It doesn’t cover Shingrix which is expensive and not covered by my Medicare Part D. (I paid out of pocket – $400.)

As investors, we may be interested in telehealth companies. I am a great believer in telehealth services which are a win-win for the doctor and the patient. It’s incredibly stupid to force a sick, contagious patient to travel to a doctor’s crowded waiting room when a telehealth visit takes minutes at home. Especially when the patient has equipment at home to measure temperature, blood pressure, blood sugar, spirometry, pulse rate and blood oxygen concentration.

Telehealth coverage was extended during the Covid epidemic by law. But, unfortunately, the law didn’t make this permanent. But the Center for Medicare Services is “studying” this and hopefully will include it permanently later.

“For CY 2023, we are finalizing a number of policies related to Medicare telehealth services, including making several services that are temporarily available as telehealth services for the PHE available at least through CY 2023 in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List. We announced that we are implementing the telehealth provisions in the Consolidated Appropriations Act, 2022 (CAA, 2022) via program instruction or other subregulatory guidance to ensure a smooth transition after the end of the PHE [public health emergency aka Covid epidemic]. The CAA, 2022 extends certain flexibilities in place during the PHE for 151 days after the PHE ends, including allowing payment for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for furnishing telehealth services as distant site practitioners (though note that mental health visits can be furnished virtually on a permanent basis) under the payment methodology established for the PHE, allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, and allowing certain services to be furnished via audio-only telecommunications systems.”

CMS finalized a policy to allow beneficiaries direct access to an audiologist without an order from a physician or Non Physician Provider for non-acute hearing conditions. The finalized direct access policy will allow beneficiaries to receive care for non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids. This affects those of us with hearing problems.

Doctors and administrators will doubtless read the new billing rules with great interest. Patients should also read these rules. Medicare supplemental insurance will only cover billing that Medicare accepts.

This is the open enrollment period for Medicare Part D and Medicare supplemental. I’m in the middle of changing both our insurance companies. Ask about a “Household discount” if both spouses are covered. This will save us $30 a month. The annual open enrollment period is a major pain. Many elderly people aren’t computer-literate, not to mention the hassle of contacting alternate insurance companies to ask for details. Just 3 in 10 (29%) Medicare beneficiaries compared their current Medicare plan with other Medicare plans offered in their area.



We are also changing our plans. It turns out that the high deductible F and G plans have the same amount of coverage and the amount of the deductible is less than the price difference to the standard plans .

Sort of a no-brainer



Good info, Wendy. Thanks