On August 3rd, 2020, the Centers for Medicare and Medicaid Services (CMS) released their proposed rule for the calendar year of 2021. These changes would affect the Physician Fee Schedule and are said to be part of their strategy of improving accessibility, quality, affordability, empowerment, and innovation. While these are only the proposed rules and the final ruling will be forthcoming in the 4th quarter of CY 2020, the proposed rule does serve as a good indicator of the direction CMS wants to take the US healthcare system. While there are too many proposed changes to discuss them all in one newsletter, the following are some of the highlights.
CPT Code Additions, Changes, and Reimbursement
As part of CMS’ response to the CoVID-19 pandemic, they reduced the regulatory burden on telehealth and virtual care, allowing providers who previously had not offered virtual care to develop these services. There has been much speculation about whether these reduced burdens will become permanent and CMS is taking its first step towards ‘the new normal’ with telehealth. In the CY2021 proposed rule:
E/M Structure Change
In 2019, CMS proposed changes to the PFS and E/M visits for the 2021 calendar year. Their initial proposal was to combine various E/M codes to reduce the redundancies and documentation burden on providers. After stakeholder feedback however, CMS altered its final ruling and has opted for to implement the E/M changes depicted below in the CY 2021.
|HCPCS Code||Current Total Time (min)||Current wRVU||CY 2021 Total Time (min)||CY 2021 wRVU|
In addition to these changes, CMS is proposing to alter the documentation requirements for E/M visits and removing the required categories of exam and history. Instead, the documentation of levels 2-5 would be based wholly on either medical decision making or total time spent on the visit on the date of service, both in-person and non-face-to-face. These changes would take effective on January 1, 2021.
One of the many changes implemented by CMS during the public health emergency related to CoVID-19 is that direct supervision by interactive telecommunications technology was allowed on a temporary basis. This was done to limit providers’ exposure to CoVID-19 patients and since the public health emergency has not resolved yet, CMS is proposing to extend this provision through December 31, 2021. This provision allows supervising providers to conduct their supervisory responsibilities via telecommunications technology, effectively temporarily eliminating the mileage restrictions that were previously in place.
Secondly, CMS is proposing to allow mid-level providers and therapists to review and verify documentation that was entered by members of the medical team for their own services billed under the physician fee schedule. Students, however, still need to have their documentation reviewed by the billing physician.
In a similar vein to supervision is the proposed rule to permanently remove the burden of diagnostic testing supervision. Under this proposal, CMS will permanently allow mid-level providers to oversee diagnostic testing, which was a temporary rule enacted by CMS as part of their response to the CoVID-19 pandemic.
Another key category of updates for the CY2021 is in the Quality Payment Program, or QPP. To read the entire QPP Fact Sheet, click here. This program has been CMS’ rollout of a payment model centered more and more around quality, as opposed to the current fee-for-service model. The QPP has several key aspects, most notably the Merit-Based Incentive Payment System (MIPS), MIP Value Pathways (MVPs), and the Alternative Payment Model (APM) and Performance Pathway (APP). Here are some key takeaways from this year’s proposed rule:
Participation Pathways (MVPs and APPs)
MIPS Program Updates
CMS has proposed a bold set of rules for CY2021, of which these are just a few. Among the other proposed rules are changes or clarifications to remote monitoring services, immunization services, pharmacists billing incident to, therapy assistants furnishing maintenance therapy, payment for services of teaching physicians, treatment of Opioid Use Disorder by Opioid Treatment Programs (OTP), and several others.
For a complete list of the proposed rules for CY2021, please click here (for information related to hospitals, IRF, and other proposed changes, click ‘next’ at the bottom of the page). As always, WebsterRogers has a dedicated team of healthcare consultants to help answer questions and provide timely guidance so you can safely navigate the ever-changing landscape of the US healthcare industry.