7 Things to Know About Medicare for 2022

As we prepare for 2022, the Centers for Medicare and Medicaid Services (CMS) has released a variety of information healthcare providers need to know about billing Medicare in the new year. We’ve created a short list of the top seven things providers should know.

Medicare Fee Schedule

In November, CMS released the 2022 Medicare Physician Fee Schedule. For a detailed look at some of the provisions that were part of that final rule, check out our blog post, “2022 Medicare Physician Fee Schedule: What You Need to Know.”

Since that final rule, however, Congress has stepped in to mitigate a significant decrease to physician income. Specifically, the legislation reduces a 3.75 percent cut to the 2022 conversion factor down to .75 percent instead. The new conversion factor will be around $34.63, up from the anticipated $33.60.

For a data source of the updated fees for Indiana and Michigan, visit WPS GHA’s webpage of downloadable fee schedules. A zipped file of updated fees for all states is available on the CMS Physician Fee Schedule webpage. (NOTE: Because of last minute changes to the 2022 Medicare Physician Fee Schedule, those updated fee schedules may not yet be available.)

Medicare Sequestration and Pay-Go

Apart from the conversion factor decreases, physicians’ Medicare income was expected to be further negatively impacted when the pause in the two-percent sequestration cuts expired on December 31, 2021.

The Budget Control Act of 2011 required mandatory across-the-board reductions in federal spending, also known as sequestration, and since that time, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, have incurred a 2 percent reduction in Medicare payment.

However, as part of the COVID-19 Cares Act in March 2020, Congress temporarily suspended the Medicare sequestration through December 31, 2020, which was later extended to December 31, 2021. Now, Congress has extended that deadline again to March 31, 2022, at which time a 1 percent sequestration reduction to Medicare payments will resume until June 30, 2022. At that time, the full 2 percent sequestration will resume.

In addition, a 4 percent cut to Medicare reimbursements, prompted by the Pay-As-You-Go (PAYGO) Act, was expected to go into effect on January 1, 2022. Congress also delayed the start of that cut until January 1, 2023.

In total, the nearly 10 percent cuts that physicians were facing have been trimmed back to an average of 2 percent for the year.

Medicare Part B Premiums

The standard monthly premium for Medicare Part B enrollees will be $170.10 in 2022, an $21.60 increase from 2021.

“The increase in the Part B premium for 2022 is continued evidence that rising drug costs threaten the affordability and sustainability of the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure in a statement. “The Biden-Harris Administration is working to make drug prices more affordable and equitable for all Americans, and to advance drug pricing reform through competition, innovation, and transparency.”

By law, Medicare Part B premiums must equal 25 percent of the estimated total costs of Part B spending for people aged 65 and over.

About 7 percent of Medicare beneficiaries pay increased premiums based on a sliding scale of incomes greater than $91,000 per year for beneficiaries who file individual tax returns, or greater than $182,000 for joint filers. Depending on their modified adjusted gross income, beneficiaries might pay as much as $578.30 in monthly premiums in 2022.

These premiums do not apply to Medicare Advantage or prescription drug plans, whose premiums are determined separately.

Medicare Part B Deductible

CMS also announced that the annual deductible for all Medicare Part B beneficiaries is $233 in 2022, an increase of $30 from the annual deductible of $203 in 2021. This deductible does not apply to Medicare Advantage or prescription drug plans, whose deductibles are determined separately.

Medicare Part A Premiums

About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $274 in 2022, a $15 increase from 2021.

Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $499 a month in 2022, a $28 increase from 2021.

These premium amounts also do not apply to Medicare Advantage or prescription drug plans.

Medicare Part A Deductible/Coinsurance

The Medicare Part A inpatient hospital deductible for beneficiaries admitted to the hospital will be $1,556 in 2022, an increase of $72 from 2021. This covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. For days 61-90, Medicare beneficiaries will pay a coinsurance amount of $389 per day in a benefit period, and $778 per day for lifetime reserve days.

For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $194.50 in 2022.

These deductibles and coinsurances also do not apply to Medicare Advantage or prescription drug plans.

MIPS

As the Merit-Based Incentive Payment System (MIPS) enters its sixth year, eligible providers should plan to continue (or begin) to participate. Not participating in the program in 2022 or failure to meet certain program standards could result in a -9 percent payment adjustment of covered professional services paid under or based on the Medicare Physician Fee Schedule in 2024.

For 2022, providers also have to achieve a threshold of 75 points to be eligible for an incentive payment, up from 60 points in 2021. And performance categories will be weighted as follows for individual MIPS eligible clinicians, groups, and virtual groups reporting traditional MIPS. These values represent slight changes from 2021 (as noted below):

Quality = 30% (down from 40% in 2021)
Cost = 30% (up from 20% in 2021)
Promoting Interoperability = 25%
Improvement Activities = 15%

Providers planning to participate in 2022 MIPS via Qualified Clinical Data Registries (QCDRs) or Qualified Registries can now access a list of those registries that have been approved by CMS to collect and report clinical data to the MIPS program on their behalf.

2022 Qualified Registries Qualified Posting {AUTOMATIC DOWNLOAD}
2022 QCDRs Qualified Posting {AUTOMATIC DOWNLOAD}

Providers can check their eligibility for MIPS in 2022 or earlier years by visiting CMS’s Quality Payment Program Participation Status page.

Also, CMS is once again applying an Automatic Extreme and Uncontrollable Circumstances (EUC) Policy for the 2021 MIPS Performance Year in response to the COVID-19 Public Health Emergency (PHE). The policy affects providers differently depending on how they report MIPS. For instance, the automatic EUC policy applies only to MIPS eligible clinicians who participate in MIPS as individuals and not to groups, virtual groups, or Alternative Payment Model (APM) Entities.

However, because reporting beyond the individual level is optional in most cases, if groups and APM entities are not able to report MIPS data for 2021, the individually eligible MIPS clinicians in those groups and APM entities will still qualify for the automatic EUC policy. Virtual groups and some small practices operate under different guidelines, however, and their members may not benefit from the automatic policy. However, 2021 EUC Exception Applications can be submitted through December 31, 2021, by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation.

To see how the MIPS automatic EUC policy might affect you, review our blog post: “Another Year of COVID-19, Another MIPS Automatic Extreme and Uncontrollable Circumstances Policy.”

Other key MIPS dates and deadlines to keep in mind as we wrap up 2021 and begin 2022:

December 31, 2021 – To receive approval to participate as a virtual group for the 2022 performance year, groups must submit an election to CMS via e-mail (MIPS_VirtualGroups@cms.hhs.gov) by 11:59 p.m. ET.
January 1, 2022 – The payment adjustments based on performance year 2020 go into effect and the 2022 performance year begins.
January 3, 2022 – 2021 MIPS performance year data submission window opens.
March 31, 2022 – 2021 MIPS performance year data submission window closes.