With the recent release of the Centers for Medicare & Medicaid Services’ (CMS) calendar year 2025 physician fee schedule proposal, significant updates are on the horizon that could impact healthcare providers nationwide. At Zyter|TruCare, we aim to provide a clear breakdown of the proposed changes to help healthcare organizations prepare and adapt effectively. This blog explores critical adjustments in payment rates, enhancements in behavioral health, expansions in telehealth, and updates to quality and savings programs.
Deciphering CMS’s CY 2025 Physician Fee Schedule Proposed Rule
Payment Adjustments
For CY 2025, the proposed rule suggests reducing the conversion factor by 2.8%, bringing it down to $32.36 from $33.29 the previous year. This reduction reflects the sunset of a temporary statutory payment increase from CY 2024, a zero percent update under specific Medicare legislation, and a minor budget-neutrality adjustment. Healthcare providers will need to strategize financially to accommodate these decreased payment rates.
Codifying Caregiver Education
One area of potential financial recoupment is a newly proposed payment model for caregiver education. For select training topics performed by the provider, either in office or through telehealth modalities, payments would be rendered. These training topics also include caregiver behavior management and modification training, further ensuring effective at-home care.
Enhanced Behavioral Health Support
As part of expanding the CMS Behavioral Health Strategy, additional actions have been proposed to support member access to behavioral health. Coding and payment structures to support safety planning interventions and post-discharge follow-up care bundling for crises such as suicidal ideational ideation and risks of suicide or overdose are being proposed. Digital mental health devices will be covered under three HCPCS codes, with surveillance of efficacy and adherence to follow. In addition to these, to better address the opioid epidemic and support behavioral health, CMS plans to permanently establish increased payments to opioid treatment programs, specifically to include new overdose reversal medications approved by the FDA. Further proposals aim to extend telehealth flexibility for these treatment programs, promoting broader and more effective patient outreach.
Telehealth Waiver Extensions
The proposal includes extending various telehealth waivers through 2025. These include continuing to allow healthcare providers to use their practice address instead of home addresses for telehealth services, enabling rural clinics to bill for these services, and maintaining virtual supervision for medical residents.
Quality Payment Program Updates
The introduction of six new optional Merit-based Incentive Payment System Value Pathways (MVPs) for 2025 is highlighted, alongside a call for input on requiring MVP participation starting in CY 2029. These pathways aim to simplify reporting and enhance the focus on quality outcomes.
Adjustments to Medicare Shared Savings Program
To ensure accuracy in financial assessments, CMS suggests excluding payments related to significant, anomalous, or suspicious billing activities from financial calculations and historical benchmarks for reconciliation, starting CY 2024. This change seeks to maintain the integrity and fairness of performance evaluations.
Zyter|TruCare’s Role in Assisting Providers with Regulatory Adaptations
Zyter|TruCare is committed to supporting healthcare providers through these regulatory updates with robust solutions and tools. Our platform simplifies navigating these changes, from adjusting to new payment models and enhancing behavioral health capabilities to leveraging telehealth expansions. With targeted analytics and streamlined workflows, Zyter|TruCare helps providers focus on delivering quality care without the burden of administrative challenges.
Moving Forward Together
The CMS’s CY 2025 proposed rule reflects significant strides toward enhancing healthcare access and quality, strongly emphasizing behavioral health and telehealth. As stakeholders review and provide feedback until September 9th, it’s time to prepare for these changes. Zyter|TruCare remains a dedicated partner in this journey, ensuring providers meet regulatory demands and continue to deliver exceptional healthcare.
Embrace the future of healthcare with Zyter|TruCare. Discover how our solutions can facilitate a smooth transition to the updated CMS regulations and enhance your operational effectiveness. Contact us today to learn more.
