SNF Sector Applauds CMS for Equalizing Doc Payments

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) has released a review of the CMS final rules for the Calendar Year (CY) 2027 Payment Policies under the Physician Fee Schedule (PFS), and the CY 2027 Home Health Prospective Payment System. 

The comments are from a blog authored by Dan Ciolek, associate vice president of therapy advocacy, and John Kane, senior vice president of reimbursement policy.

In the PFS, the association said “the most encouraging news is that the PFS final rule fixes a policy error from last year to recalibrate SNF physician payments to be the same for both long-stay residents and short-stay patients. It also delayed certain changes to remote patient and therapeutic monitoring [RPM/RTM] policies that would have been challenging.”

At issue was a change last year when Medicare gave doctors visiting Part B (long-stay) SNF patients a 4 percent payment increase. At the same time, Medicare cut payments 7 percent for doctor visits to short-stay SNF residents (Part A). In the final rule, CMS said the payments would be the same and at the higher rate.

Here are parts of the AHCA/NCAL breakdown. See the links below for the full association blog post and three Park Place articles on PFS.

PFS Keys

• PFS Payment Rates Down: Providers able to participate in PFS incentive programs will have a 1.83 percent reduction in their PFS conversion factor in CY 2027, while providers not able to participate will have a 2.31 percent reduction in their PFS conversion factor. 

  
  

• Telehealth: Telehealth flexibilities policies extend through Dec. 31, 2027, while audio-only telehealth authority extends through Jan. 1, 2028, and geographic and originating site restrictions remain waived through 2027, the blog post said. CMS also finalized new telehealth billing modifiers and added several new services to the Medicare Telehealth List, including speech-language pathology, advance care planning, and shared medical appointments.  

  
  

• Physical Therapy, Occupational Therapy, or Speech-Language Pathology Policies: CMS finalized increases to the annual therapy threshold, including $2,540 for Physical Therapy + Speech-Language Pathology (SLP) combined and $2,540 for Occupational Therapy. Targeted medical review threshold remains $3,000 through CY 2027. AHCA/NCAL said in addition, the agency finalized several changes to SLP coding, including that several new SLP codes be designated as Always Therapy services, and excluded the 15-minute add-on codes from MPPR. CMS also made final a new optional SLP Healthcare Common Procedure Coding System code GSLPP for the treatment of speech, language, voice, communication, and/or auditory processing disorders for pediatric patients.

    

• RPM and RTM: CMS finalized most of its proposed changes, with multiple changes adopted in full or in part, including preserving important RPM/RTM resources/flexibility and providing meaningful initiating-visit flexibility, including telehealth, use of visits addressing other needs, and protection for beneficiaries already receiving monitoring before Jan. 1, 2027, the blog said. AHCA/NCAL said the adopted RPM/RTM employment restriction remains a major concern. CMS delayed implementation until Jan. 1, 2029.

  
  

Home Health Keys

• CMS did not finalize its proposal to allow denial of one enrollment to trigger revocation of a provider’s other enrollments, AHCA/NCAL said.

    

• CMS also withdrew proposed expansions of debt-based and payment-suspension denial authorities involving additional associated parties and business or financial relationships. 

  
  

  “These decisions addressed AHCA/NCAL’s concerns that broad enforcement authorities could jeopardize otherwise compliant providers based on circumstances insufficiently connected to their operations,” the blog post said.

   

  Read the entire AHCA/NCAL blog post at What’s In The Physician Fee Schedule and Home Health Final Rules.

Read three Park Place articles on the payment equalization language at CMS’s Final Doc Payment Rule Keeps Win for SNF Physicians | Park Place, SNF Sector Digests Physician Payment Rule, Gives Initial Takes | Park Place, and Big Win for SNF Care; CMS Seeks ‘Equalized’ Payment in New Rule | Park Place.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.