News & Media

2021 Physician Fee Schedule Proposed Rule with Comment Period

Wednesday, September 30, 2020

 

On August 3, 2020, the Centers for Medicare and Medicaid Services (CMS) issued the 2021 Physician Fee Schedule (PFS) proposed rule and is soliciting public comments on proposed policy changes for Medicare payments under the PFS.  Public comments are due by October 5, 2020.  Comments can be submitted at http://www.regulations.gov.  Follow the ‘‘Submit a comment’’ instructions.  The proposed rule can be located at https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-p

Significant positive changes are related to coding and payment for evaluation and management (E/M) physician office-visit services are included.  CMS will implement increases to the payment for office visits, based on recommendations on resource costs from the AMA/Specialty Society RVS Update Committee (RUC).  However, an 11% cut in the Medicare conversion factor is necessitated by proposed additional spending of $10.2 billion. The RUC recommendations for office-visit payment increases account for only half of this additional spending, and therefore, half of the reduction. The remaining spending increases and resulting conversion factor reduction are attributed to various CMS proposals to increase valuation for specific services.  MSMS, the AMA and others are advocating for Congress to waive Medicare’s budget-neutrality requirement for the office visit and other payment increases. 

Key elements of the E/M office-visit overhaul include:

  • Eliminating history and physical exam as elements for code selection.  While significant to both visit time and medical decision-making, these elements alone should not determine a visit’s code level.
  • Allowing physicians to choose whether their documentation is based on medical decision-making or total time. This builds on the movement to better recognize the work involved in non-face-to-face services like care coordination.

  • Changing medical decision-making criteria to move away from simply adding up tasks to instead focus on tasks that affect the management of a patient’s condition.

Gradual implementation of the Merit-based Incentive Payment System (MIPS) would continue under the proposed rule.  Proposed changes include:

  • Lowering the weight of the quality category to 40% from 45% of the MIPS final score.
  • Raising the weight of cost category from 15% to 20% of the final score.
  • Adding telehealth services to the list of cost measures.

A significant new proposal involves an optional and completely attestation-only measure in the promoting interoperability (PI) category that can replace two other PI measures giving physicians 40 points for participating in Health Information Exchanges.  CMS notes that it will continue policy development for its planned MIPS Value Pathways (MVPs), but will is delaying implementation.

CMS proposes reducing the number of quality measures for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program from 23 to six and proposes a quality performance score equivalent to or above the 40th percentile across all MIPS quality performance-category scores to share in savings or avoid owing maximum losses.

Recognizing the evolving nature of the nation’s drug overdose epidemic, CMS proposes broadening the use of G-codes used in the treatment of OUD. This year, CMS established codes for the development of a treatment plan, care coordination and individual and group counseling.  For 2021, CMS proposes modifying these codes so they can be used to report monthly treatment for patients with any substance-use disorder—not just OUD.

As mentioned previously, comments are due to CMS by October 5, 2020.  Typically, CMS releases the final rule around November 1, which is 60 days before it takes effect on January 1. However, citing the pandemic, CMS is waiving that requirement and replacing it with a 30-day notification requirement, so the final payment schedule is not expected to be released until December 1, 2020.