Payers are incentivizing physicians to perform procedures in low-cost settings, which means CHWs are becoming increasingly attractive. At the same time, doctors are balking at some payer moves over the past 30 days.
Four of the highest paying moves this month for CHWs:
1. Physicians face another year of fee cuts in 2023 as Medicare proposes to cut the conversion factor by 4.42% to $33.08. Many physicians oppose the proposed cuts, arguing that continued reductions in physician fee schedules would create long-term financial instability within the program and threaten patient access to Medicare-participating physicians.
2. Medicare recommends removing 10 procedures from the inpatient-only list in 2023, according to the rule proposed by the Prospective Inpatient Payment System and the Ambulatory Surgical Center Payment System, released July 15.
3. Cigna delays implementation of its Modifier 25 policy. Reimbursement policy requires submission of medical records with all assessment and management claims with CPT 99212-99215 and Modifier 25 when a minor procedure is billed .
4. Aetna will no longer require prior authorization for cataract surgery or video electroencephalography procedures. For spinal fusion and cervical artificial disc surgeries, Aetna will no longer require pre-certification for the service site. Surgeries still need to be pre-certified.