Episode 72: Impact of 2021 Fee Schedule Changes on Physician Compensation

Justin Chamblee, Alex Kirkland, and Amit Vaishampayan join Mark Reiboldt to discuss the proposed changes to the Medicare Physician Fee Schedule (MPFS). There are three noteworthy changes proposed, including evaluation and management (E/M) coding and payment changes, permanent telehealth changes implemented in response to the pandemic, and updates to the Quality Payment Program (QPP).

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Episode Synopsis

E/M Coding and Payment Changes

Due to increasing RVU amounts, the statutory budget neutrality mandate comes into play to reduce the conversion factor by $3.83 to $32.2605 to prevent an increase in healthcare costs. The Budget Neutrality Act requires that increases or decreases in RVUs may not cause the value of expenditures for the year to change more than $20 million in the absence of changes. If this threshold is exceeded, adjustments are made to preserve budget neutrality.

 

Telehealth Changes

The Centers for Medicare and Medicaid Services (CMS) are adding several telehealth CPT codes that are similar to existing consultations and office visits. They also added temporary codes during the pandemic that will continue to be evaluated. CMS is seeking comments to determine future usage as well as additional temporary codes.

 

QPP Updates

We see ACO scoring and policy changes to acknowledge that providers will not immediately recover from COVID-19, and they will need support throughout their recovery. The Merit-based Incentive Payment System (MIPS) category weightings will shift to reduce the quality weight by five percent (to a total weight of 40 percent) and increase cost by five percent (to a total weight of 20 percent).

 

Extras

Three Quick Tips to Get You Started with the New E/M Guidelines

Is Telehealth Past the Tipping Point?

Episode 71: The Ongoing Battle of Site Neutral Payments

Episode 70: Major E/M Coding Changes Coming in 2021: Here’s What You Need to Know