Published July 11th, 2024
Every year, the Centers for Medicare & Medicaid Services (CMS) issues a proposed set of changes to payment and other coverage and reporting requirements for providers offering care to Medicare beneficiaries.
Multi-step Process for Updating Payment Policy on Physician Fee Schedule and Payment Method for Federally Qualified Health Centers and Rural Health Clinics¹
This is the process and timeline for clinicians paid under the Medicare Physician Fee Schedule, as well as the separate payment systems that apply to Federally Qualified Health Centers and Rural Health Clinics.
- PROPOSED RULE | CMS issues a proposed rule with proposals related to payment
- COMMENT PERIOD | Stakeholders typically have 60 days to comment
- FINAL RULE | CMS then reviews the comments and issues a final rule no later than December 31st
- EFFECTIVE DATE | The effective date of the changes is January 1st
*There is a parallel process for hospitals and other facilities/providers, but with different timelines.
[1] From MedPAC accessed on July 11, 2024: Federally qualified health centers (FQHCs) and rural health clinics (RHCs) furnish services typically provided in outpatient clinic settings. While most clinician services furnished to Medicare beneficiaries are billed under the fee schedule for physicians and other health professionals, the Congress established special payment rules for FQHCs and RHCs to improve access to primary care services in rural and underserved areas. FQHC and RHC services are medically necessary medical visits, mental health visits, or qualified preventive health visits. For most services, the visit must be a face-to-face (one-on-one) encounter between the patient and an eligible clinician. However, beginning in 2022, mental health visits using interactive, real-time telecommunications technology are considered FQHC and RHC services.
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