Proposed Rule for 2021 Physician Fee Schedule Payments Released

Posted on August 10, 2020

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule for the Medicare fee-for-service physician fee schedule (PFS) payments, effective Jan. 1, 2021. The proposed rule would update the PFS rates and implement year five of the quality payment program created by the Medicare Access and CHIP Reauthorization Act of 2015. The CMS proposes to:

  • Reduce the conversion factor to $32.26, with the budget neutrality adjustment to account for changes in relative value units, as required by law. This would be a decrease of $3.83, or 10.6%, from calendar year 2020.
  • Add services to the Medicare telehealth list of services and make other changes to retain certain COVID-19 telehealth flexibilities.
  • Increase payment rates for office/outpatient evaluation and management visits.
  • Expand supervision of diagnostic tests by certain nonphysician practitioners.
  • Delay the next Clinical Laboratory Fee Schedule (CLFS) data reporting period by one year so that hospital outreach laboratories would not need to report private payer data before the Jan. 1 through March 31, 2022, time period.
  • Eliminate the phase-in of CLFS payment cuts through calendar year 2024.
  • Align the Medicare Shared Savings Program reporting requirements with Meaningful Measures to reduce reporting burden and focus on patient outcomes. Automatic full credit for Consumer Assessment of Healthcare Providers and Systems patient experience of care surveys will be provided for performance year 2020. More information is available on the Quality Payment Program fact sheet, which can be downloaded from the Quality Program Resource Library on the CMS website.
  • Implement provisions of the Substance Use disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, including Medicare coverage for opioid treatment programs, screening for substance use disorder in Medicare physicals and electronic prescribing of controlled substances.

The CMS will accept comments on the proposed rule through Oct. 5. The agency has waived its typical timeline for releasing the final rule, which may result in release of the final rule as late as Dec. 2 for the Jan. 1, 2021, effective date. Members with questions should contact Renée Smiddy at the MHA.

Tags: telehealth, Medicare, quality, CLFS, physician fee schedule, PFS, Clinical Laboratory Fee Schedule, Smiddy

Posted in: Member News

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