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Medicare Physician Fee Schedule 2021

Medicare Physician Fee Schedule 2021

The CY 2021 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on August 4, 2020. This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2021.

“During the pandemic, physicians have responded heroically in the face of challenges to keeping their practices open and treating their patients. COVID-19 has exposed weaknesses in our health care system as well as opportunities for improvement,” said AMA President Susan R. Bailey, M.D. “Our comments are intended to ensure physicians can continue providing the highest quality care for Medicare beneficiaries during and after this public health emergency. To achieve this, we recommend that CMS prevent the steep budget neutrality cuts that are pending and continue the forward-looking changes for telehealth patients.”

According to American Medical Association, while providers are generally supportive of increased investments in primary care and chronic disease management, the reduction would result in a 5.5 percent cut to physician payment in 2021, bringing total cuts to nearly 11 percent after accounting for other proposals in the rule.

“Payment reductions of this magnitude would be a major problem at any time, but to impose cuts of this magnitude during or immediately after the COVID-19 pandemic, including steep cuts to many of the specialties that have been on the front lines in efforts to treat patients in places with widespread infection, is unconscionable,” the group stated in a comment letter to CMS.

Provider industry groups also advised CMS to support telehealth coverage proposals in the final version of the 2021 Medicare Physician Fee Schedule.

“CMS telehealth policy changes during the PHE enabled patients to get much needed care,” the AMA said. “Patients and physicians now understand the value and importance of telehealth. Consequently, the AMA urges CMS to continue to strengthen telehealth policies: making permanent several telehealth services, removing geographic and site of service barriers, and continuing to cover services through the end of the year following the year in which the PHE ends. These services should include audio only visits.”

“It has become clear that many patients do not have access to the devices or the broadband services necessary to receive care through video-based technology, such as a smartphone,” AMGA, one of those industry groups, stated. “For some patients, the choice is between an audio-only telephone call and no visit at all. Since then, our members have confirmed the importance of audio-only visit. A large number of patients simply do not have the means to access care if a video component is required.”

CMS proposed the APP to facilitate the transition from the Merit-Based Incentive Payment System (MIPS) to alternative payment models (APMs). As part of that effort, the agency proposed to score APM participants using a smaller set of standard quality measures and sunset the CMS Web Interface for data collection in 2021.

Meanwhile, value-based providers advised CMS to not finalize the elimination of the pay-for-reporting year currently provided to ACOs at the start of a Shared Savings Program contract. As per provider’s feedback, the Medicare Physician Fee Schedule has a wide reach and will significantly impact physician reimbursement.

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