CMS Finalizes 2021 Physician Fee Schedule, Tinged with a Bit of Controversy

By Jonathan Springston, Editor, Relias Media

The Centers for Medicare & Medicaid Services (CMS) this week finalized the 2021 physician fee schedule (PFS), set to go into effect Jan. 1, which includes telehealth expansion, targeted rural health assistance, and more streamlined coding and documentation regulations.

The rule also includes what CMS called “a historic increase” in the payment rates for office/outpatient face-to-face evaluation and management (E/M) visits. But because of a federal stipulation regarding budget neutrality, to finance this increase CMS had to make cuts elsewhere — in this case, payment reductions to other medical services covered by Medicare.

“Emergency physicians and other healthcare providers battling on the frontlines of the ongoing [COVID-19] pandemic are already under unprecedented financial strain as they continue to bear the brunt of COVID-19,” Mark Rosenberg, DO, MBA, FACEP, president of the American College of Emergency Physicians (ACEP), said in a statement. “These cuts would have a devastating impact for the future of emergency medicine and could seriously impede patients’ access to emergency care when they need it most.”

In its own statement, the American Medical Association (AMA) lamented the “shocking reduction,” concurring with ACEP that such a change is the last thing a battered industry needs right now.

CMS’ move this week is the culmination of a situation that has been brewing since August when the agency first released the rule proposal for public comment. Back then, the AMA and other groups asked CMS to postpone the budget neutrality provision or waive it altogether, at least this one time.

Now, preventing the controversial cuts from becoming reality would take congressional intervention. A bipartisan group of House lawmakers have been working on just such a proposal — “Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020.” The resolution would freeze the Medicare reimbursement rates at 2020 levels for two years. In November, a coalition of 74 healthcare organizations sent a letter to Congress in support of this proposal.

Elsewhere, CMS has courted other controversy with its rulemaking authority — namely, price transparency. In another rule that will go into effect on Jan. 1, 2021, most private health plans, including group health plans and individual health insurance market plans, must disclose pricing and cost-sharing information. Some hospitals were holding off, hoping courts would overturn the requirements. Other facilities still are contending with operational challenges caused by COVID-19. Nevertheless, expectations have changed — and the consequences of noncompliance are real, as reported in the January 2021 issue of Hospital Access Management (HAM).

But are facilities really ready for the responsibility? What about patients — are they aware of this new regulation, where to find pricing details, or educated enough to understand the details of what they do find? Be sure to check out January HAM for more discussion of these issues.