Glimpsing the future: Legal challenges, COVID rules (again), new codes and more

Why This Topic Matters

It highlights where practices may see policy shifts, audit pressure, and operational change, helping readers decide which reimbursement, compliance, and coding updates deserve closer attention in the coming year.

Article Sections

1. 2023 predictions

   Introductory framing for the annual outlook and the range of coming changes covered in the article.

2. Behavioral health will grow — but not quickly, until bigger changes are made

   Discusses behavioral health adoption, Medicare strategy changes, technology adoption, and payer and provider trends.

3. Practices will be challenged by the differences between CPT guidelines and Medicare rules for facility-based E/M visits

   Reviews anticipated differences between professional guideline updates and Medicare billing policy for evaluation and management services.

4. The biggest compliance hot-spots in 2023 will be COVID-related and telehealth fraud

   Covers fraud enforcement priorities, telehealth program integrity, privacy and security concerns, and other emerging compliance risks.

5. Providers will benefit from more improvements to the No Surprises Act (NSA)

   Summarizes litigation and rulemaking activity affecting the dispute resolution framework under the NSA.

6. Permanent Medicare reimbursement reform will remain elusive

   Addresses broader payment reform concerns, congressional action, and the outlook for Medicare reimbursement policy.

7. Behavioral health care management will start small, go the outside route

   Examines the early outlook for a newer behavioral health care management service and the likely practice adoption challenges.

8. More practices will turn to remote monitoring for patients

   Discusses growth in remote monitoring, vendor offerings, and upcoming contractor and advisory activity.

9. The AMA and CMS will continue to work out their differences on prolonged service codes

   Covers ongoing differences in prolonged service coding policy and anticipated review by professional and federal bodies.

10. The PHE will persist through 2023

    Looks at the continued impact of the public health emergency on telehealth and pandemic-era treatment and reimbursement flexibility.

11. Practices will see more activity from a broad range of external auditors

    Highlights audit trends, error-rate data, and documentation-related issues that may drive additional review activity.