Latest Changes and Updates In Healthcare Billing Regulations 2023

In 2023, similar to previous years, medical billing and coding regulations have been updated. While some of these 2023 medical billing updates are easy to accommodate, others have been reported to need to be more precise and more manageable for healthcare workers.  

Even the smallest updates, like the changes with the QPP (Medicare’s Quality Payment Program), are noteworthy. The coding and billing guidelines are modified each year to elevate the quality of services rendered and patient care. 

It is crucial for your healthcare staff to stay on top of these updates to avoid potential claim denials, lawsuits, delayed reimbursement, and fraud. Read on to learn about the 2023 billing and coding updates and how optimizing them will help your practice.

Updated Medicare Payment Policy

As for updates on physician billing, the original decrease in the conversion factor was a 4.5% reduction to the Medicare Physician’s Fee Schedule payments which was opposed by the majority of physicians. 

So, after groups in the healthcare industry counteracted this decrease in conversion rates by joining hands and asking Congress to lower them, Congress decided to lower the reduction to 2% in 2023, increasing it again to around 3.5% in the coming year, 2024, considering the financial challenges faced by healthcare providers during the pandemic. 

There was also a split-shared visits policy finalized in 2022 by the Centers for Medicare and Medicaid Services(CMS) which was delayed after around 20 physician organizations wrote to CMS, citing their concerns on how the implementation of this policy would negatively impact patient experience and any collaborative care delivery models. According to this policy, in 2024 any shared/split visits are to be billed under the National Provider Identifier (NPI) of the individual who provides a total visit time of more than 50%. For instance, if a physician and an NPP both provide care to the patient, provided that a substantive portion of the physician’s assistant’s time is spent caring for the patient, then the visit will be billed under the NPP’s National Provider Identifier. This leaves the practice with only a Physician Fee Schedule Rate of 85%. Whereas, in 2022, visits shared between a physician and an APP were billed under the NPI of any non-physician practitioner or physician who either provided more than 50% of the total service time or documented the support for medical decision-making, exam, and history.

Modifier JZ 2023

On January 1, 2023, a new modifier known as the Modifier JZ, announced by the Internal Revenue Service (IRS) came into effect. The purpose of this modifier was to streamline the reporting of any services provided in hospital or outpatient settings. 

The JZ Modifier is reported on the same line as the CPT code for a service it is applied to. It offers more clarity for medical claim processing and allows better tracking of services provided in outpatient settings or hospitals. For instance, if a patient received a service or supply at a waived or reduced rate because they are eligible for a government program like Medicare or Medicaid, the JZ Modifier will be applied to the CPT code of the services provided. 

It is one of the critical medical billing updates of 2023 which healthcare providers must familiarize themselves with if they want to receive timely reimbursement.

JG Modifier

CMS proposed that starting from January 1, 2o23 the JG Modifier will be used for identifying the 340B drugs. Hospitals like children’s hospitals, PPS (Prospective Payment System) exempt cancer hospitals, and rural sole community hospitals will continue to use the TB modifier for similar purposes and any other hospitals will be using the JG modifier. 

That is because the JW modifier is one of the modifiers for medical billing required to be applicable when billing the waste of 304B drugs. Other appropriate modifiers in medical coding for 340B drugs like the JG modifier should be used by eligible healthcare facilities.

Codes for Biosimilars

In the 2023 CPT/HCPCS code set release, CMS has included new drug code biosimilars which are FDA-approved medications. These medications are similar to other biological drugs in dosage, usage, efficacy, and potential side effects but they cost relatively less. 

CMS is reported to reimburse the biosimilars with an ASP equal to or less than ASP 8% which is the reference biological price. This is done to drive down drug costs and boost the production of biosimilars. 

Considering that the reference biological reimbursement is APS 6%, the 2% increase for biosimilar drugs is a step forward to a greater impact on patient care. This increase started back in October 2022 and is set to continue for up to five years.

FAQs

1. What are the changes in CPT coding for 2023?

CPT codes have gone through multiple changes in 2023, including: 

• 93 revised codes and 75 CPT codes were deleted. 
• Changes to the evaluation and management (E/M) codes and Covid-19 vaccination codes. 
• Except for anesthesia, all departments of the CPT 2023 code set were recorded to have coding and guideline changes. 

2. What are the ICD 10 changes for 2023?

The ICD-10 changes for 2023 include several terms being modified, 251 codes being deleted, and 36 ICD-10 codes being converted into parent codes. There are around 1176 new billable ICD-10 codes in 2023, among which some major changes are recorded in endometriosis, motorcycle accidents, head injuries, maternal care for fetal disorders, and dementia. 

3. Can you bill for a PA under the supervising physician?

It can depend on payer requirements. For instance, some payers can enroll or credential PAs while others can require any services rendered by the PA to be billed under the National Provider Identifier (NPI) of their supervising physician. 

4. How many CPT codes are there in 2023?

The CPT code set for 2023 has 10,696 codes, describing services and medical procedures that are available to patients. This set includes at least 93 revisions, 75 deleted codes, and the addition of 225 new codes. The CPT code set will further evolve with growing innovation.