The Centers for Medicare and Medicaid Services (CMS) has issued a range of information for healthcare providers to know about invoicing Medicare in the New Year as we prepare for 2022. We’ve compiled a list of the few things suppliers should be aware of.

Medicare Fee Schedule

CMS published the 2022 Medicare Physician Fee Schedule in November. However, Congress has intervened since that final regulation to minimize a large drop in physician pay. The law, in particular, decreases a 3.75 percent drop to the 2022 conversion factor to.75 percent. The new conversion factor is expected to be roughly $34.63, up from $33.60. A zipped file containing revised rates for all states is accessible on the CMS Physician Fee Schedule website.

Medicare Sequestration and Pay-Go

Aside from the conversion factor reductions, physicians’ Medicare income was predicted to be reduced further when the halt in the two-percentage-point sequestration cutbacks expired on December 31, 2021. Since the Budget Control Act of 2011, which mandated mandatory across-the-board reductions in federal expenditure, popularly known as sequestration, Medicare FFS claims with dates of service or discharge on or after April 1, 2013, have experienced a 2% reduction in Medicare payment.

However, as part of the COVID-19 Cares Act passed in March 2020, Congress temporarily postponed Medicare sequestration until December 31, 2020, which was then extended until December 31, 2021. Congress has extended that deadline until March 31, 2022, after which a 1% sequester cut to Medicare payments would resume until June 30, 2022. At that point, the full 2% sequestration will resume. The Pay-As-You-Go (PAYGO) Act led to a 4% drop in Medicare reimbursements, which was set to take effect on January 1, 2022. Congress also postponed the implementation of that reduction until January 1, 2023. In sum, roughly 10% of physicians’ cutbacks have been reduced to an average of 2% for the year.

Medicare Part B Premiums

In 2022, the usual monthly premium for Medicare Part B subscribers will be $170.10, an increase of $21.60 from 2021. “The increase in the Part B premium for 2022 is another indication that escalating prescription costs jeopardize the Medicare program’s affordability and sustainability,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Through competition, innovation, and openness, the Biden-Harris Administration is trying to make prescription costs more reasonable and equitable for all Americans, as well as to advance drug pricing reform.”

By law, Medicare Part B premiums must match 25% of the expected total expenditures of Part B spending for those aged 65 and up. Around 7% of Medicare beneficiaries pay higher premiums based on a sliding scale of incomes larger than $91,000 per year for individuals filing individual tax returns or greater than $182,000 for joint filers. Beneficiaries might pay as much as $578.30 monthly premiums in 2022, depending on their adjusted gross income. These rates do not apply to Medicare Advantage or prescription medication plans, which have their premiums.

Medicare Part B Deductible

The CMS also stated that the yearly deductible for all Medicare Part B enrollees would be $233 in 2022, up from $203 in 2021. This deductible does not apply to Medicare Advantage or prescription medication plans, which have different deductibles.

Medicare Part A Premiums

Since they have at least 40 quarters of Medicare-covered work, about 99 percent of Medicare recipients do not pay a Part A fee. Individuals who have had at least 30 quarters of coverage or are married to someone who has had at least 30 quarters of coverage may purchase Part A at a reduced monthly premium cost of $274 in 2022, a $15 increase from 2021. Certain uninsured elderly people with less than 30 quarters of coverage and certain disabled people who have exhausted all other entitlements will pay the entire price, which will be $499 per month in 2022, a $28 increase from 2021. These premium levels do not apply to Medicare Advantage or prescription medication plans.

Medicare Part A Deductible/Coinsurance

The Medicare Part A inpatient hospital deductible for hospitalized patients will be $1,556 in 2022, up to $72 in 2021. This pays the beneficiary’s part of the expenditures for the first 60 days of Medicare-covered inpatient hospital treatment during a benefit period. Medicare beneficiaries will pay a coinsurance fee of $389 per day in a benefit period for days 61-90 and $778 per day for lifetime reserve days. In 2022, the daily coinsurance for beneficiaries in skilled nursing facilities for days 21 through 100 of extended care services in a benefit period will be $194.50. These deductibles and coinsurances also do not apply to Medicare Advantage or prescription medication plans.

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