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The CMS 2021 Physician Fee Schedule Proposal: What Changes You Can Expect

Medical Billing

Revenue Cycle | AdvancedMD

CMS released the 2021 Physician Fee Schedule in August. If you missed the news at the time with everything going on with COVID-19 and other healthcare challenges, it’s important to understand what changes were included and how it can impact your clinic in the future. We’ll cover some important things contained in the 1,353-page proposal and dates to remember.

According to CMS, the proposed updates to the physician fee schedule are geared toward creating “a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.” As is the case each year, the fee schedule includes standard technical proposals for things like equipment pricing, geographic cost indices, and malpractice expenses to refine rates based on current market data.

Telehealth & Telemedicine Updates

Some of the most significant changes that the rule includes are adjustments to payment for telehealth and telemedicine services. Before the COVID-19 pandemic, many of these services were not reimbursed by Medicare and Medicaid, and those that were included were often reimbursed at significantly lower rates than they would be in person. It created a significant disincentive to implement telemedicine in many clinics. When COVID-19 hit, CMS adjusted reimbursement rates for telemedicine to be on par with in-person visits, and the proposed changes will continue that in most cases.

The new proposal includes some clarification on telehealth and telemedicine services, when telemedicine reimbursements are applicable, and what services are included. They are also requesting public comment on whether rules that allowed for clinician supervision with real-time audio/visual communications technologies should be extended, and how to put appropriate protections in place if it is extended.

Telehealth services, including remote patient monitoring (RPM), are now included as evaluation and management (E/M) services and eligible providers can bill Medicare for these services as long as they have an existing relationship with the patient.

Additional Changes

Other updates include implementation of the SUPPORT Act mandating e-prescribing for certain scheduled drugs to comply with prescription drug monitoring programs, as well as simplified billing and coding for certain outpatient visits that will significantly reduce the administrative burden of these visits for providers, according to the American Medical Association.

The rule also proposes changes to the Quality Payment Program by:

  • Delaying MIPS Value Pathways until 2022
  • Changing the requirements for quality reporting by ACOs
  • Replacing the APM scoring standard with the APM Performance Pathway (APP) for ACOs
  • Eliminating penalties for quality performance during 2020 because of COVID-19

Important Dates

If you want to provide public comments on the proposed changes, make sure you get those in by October 5, 2020. Specifically, CMS is soliciting comments on whether some of the rule changes put in place during the public health emergency (PHE) of COVID-19 should become permanent, or should be allowed to expire in 2021. The changes will go into effect on January 1, 2021 after the public comment period is over and the fee schedule is finalized.

It’s important to be prepared for the upcoming changes in MIPS and quality reporting, and continue to provide care through telemedicine and telehealth for your patients in light of these new rules. Schedule a demo with AdvancedMD today to learn how our software can help.



Topic: Medical Billing


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