We understand the challenges of keeping current on how to appropriately bill and code for your Medicare patients. Below are a number of resources to help you ensure that you are paid appropriately and are not in violation of any Medicare policies.
2024 Medicare Physician Fee Schedule/QPP Final Rule
CMS published the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023. The 2024 Medicare Physician Fee Schedule Final Rule includes implementation of code G2211 which better recognizes the resources necessary to provide patients with longitudinal, continuous care. ACP has spent years advocating for this type of code, which will allow clinicians to account for services like chronic disease management tracking, review of consultative or diagnostic reports, medication monitoring, safety outside of patient visits and physician input at assisted living or nursing homes. Educational resources to help internal medicine physicians understand how and when to use the G2211 add-on code will be available in early 2024.
However, because of Medicare program “budget neutrality” requirements the 2024 PFS also includes an across-the-board cut of nearly 3.4% to payment rates.
While the PFS is effective as of January 1, 2024, Congress can still stop these cuts. ACP is actively engaging in legislative advocacy through the end of January 2024 which would retroactively address the improper cuts to the fee schedule. All ACP members are encouraged to use ACP’s advocacy alert to ask your members of Congress to stop the cuts to physician payment.
Quality Payment Program (QPP)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP) to transition physicians away from a volume-based system toward one that rewards value.Learn more
Telehealth Guidance and Resources
Offering guidance on clinical use cases, technology, regulations and waivers, and billing and coding.
Getting Started with Medicare
- Medicare Enrollment Resources
- Web-based Training (WBT) Courses: Free tools from CMS that allow doctors and their staff to learn about a broad range of Medicare related issues.
- Opting out of Medicare and/or Electing to Order and Refer Services
- Additional information on Ordering and Referring from the AMA: Ordering/Referring Fact Sheet
Additional Payment Issues under Medicare
- ACP Comments on Proposed 2024 Physician Fee Schedule, Medicare Shared Savings Program, and Quality Payment Program Rule
- ACP Summary of 2023 Medicare Physician Fee Schedule (MPFS) & Quality Payment Program (QPP) Final Rule (ACP login required)
- Read ACP’s Comments on 2023 Final Physician Fee Schedule & Quality Payment Program Rule
How to Comply with Medicare Regulations
Advance Care Planning
- Advance Care Planning Tool Kit: This tool kit helps practices implement and bill for Advance Care Planning and end-of-life discussions. (ACP login required)
- FAQs on Billing Advanced Care Planning
- Advance Care Planning Fact Sheet
- Advance care planning: Administration and reimbursement
Chronic Care Management
- Chronic Care Management (CCM) Tool Kit: This new tool kit provides what practices need to implement the new CCM codes, including background information for clinicians and staff, a step-by-step implementation guide, and a sample patient agreement. (ACP login required)
- Resources from CMS: CMS' Chronic Care Management Services Fact Sheet
Transition Care Management Codes
Preventive Care Visits
- Initial Preventive Physical Examination
- Annual Wellness Visit
- IPPE and AWV FAQs
- Guide to Medicare Preventive Services Codes & Billing Information: This is an interactive PDF, in which you can click on a service at the left to view that service's information.
Home Health Face-to-Face Encounter Requirement
Care Plan Oversight Encounter Worksheet and Instructions
Care Plan Oversight Encounter Worksheet and Instructions (ACP login required)