CMS Proposed 2021 Medicare Payment and MIPS Changes: August 2020

Historical archive and source attribution (August 2020): This report was originally published by Heather Landi in Fierce Healthcare on August 4, 2020. It describes CMS’s proposed 2021 Medicare Physician Fee Schedule and MIPS changes, not final or current reimbursement instructions. CMS issued a final 2021 rule on December 1, 2020; later congressional action also altered the 2021 conversion factor. Specialty impact estimates, supervision provisions, and telehealth lists in the original report require date-specific verification. See the original reporting, CMS’s final-rule fact sheet, and current HHS Medicare telehealth payment policies.

Federal health officials released a proposed rule late Monday that sets 2021 Medicare payment rates for physicians and includes changes to the Merit-based Incentive Payment System.

The Centers for Medicare & Medicaid Services released the draft of its proposed annual Physician Fee Schedule and Quality Payment Program rule (PDF), which updates the payment rates for physician services.

As previously discussed by CMS officials, the proposed rule sought to expand the list of telehealth services covered by Medicare.

Services added include more complex visits that allow offices to bill for more advanced office/outpatient evaluation and management codes. Proposed services included prolonged services, group psychotherapy, neurobehavioral status exam, care planning for patients with cognitive impairment and home visits.

The proposed rule also will add certain services to the Medicare telehealth list for the remainder of the calendar year, however these services will not be permanently added. These services include certain home visits, emergency department visits and nursing facility discharges.

A more sweeping extension of pandemic telehealth policies, including enabling patients to get telehealth visits at home, would require Congressional action, CMS officials have said.

CMS also proposed to simplify billing and coding requirements for office and outpatient visits.

The agency plans to align its evaluation and management (E/M) visit coding and documentation policies with changes laid out by the CPT Editorial Panel for office/outpatient E/M visits, beginning Jan. 1, 2021.  

“We are proposing a refinement to clarify the times for which prolonged office/outpatient E/M visits can be reported, and are proposing to revise the times used for ratesetting for this code set,” the agency said in a fact sheet.

The American Medical Association (AMA) issued a statement supporting the E/M modifications that implement significant increases to the payment for office visits.

However, these office visit payment increases, and a multitude of other new CMS proposed payment increases, are required by statute to be offset by payment reductions to other services. This results in an “unsustainable” reduction of nearly 11% to the Medicare conversion factor, AMA said.

“For this reason, the AMA strongly urges Congress to waive Medicare’s budget neutrality requirement for the office visit and other payment increases. Physicians are already experiencing substantial economic hardships due to COVID-19, so these pay cuts could not come at a worse time,” said AMA President Susan R. Bailey, M.D. in a statement.

The CMS proposal also increases payment cuts to some specialty providers, which many medical groups already are sounding the alarm over. Physical and occupational therapists would see a 9% payment cut, according to the proposal.

The Alliance for Physical Therapy Quality and Innovation (APTQI) issued a statement Tuesday expressing concern about the “deep, across-the-board” payment cuts to physical and occupational therapy.

“We are deeply disappointed that—despite unified warnings from lawmakers, specialty providers, and other stakeholders about the potentially devastating impact of these cuts in the midst of a global pandemic—CMS nonetheless chose to move forward with Medicare specialty reimbursement reductions in 2021,” said Nikesh Patel, executive director of APTQI in a statement.

Physical therapists, psychologists and social workers complained about cuts to their Medicare reimbursements last year as well.

CMS also is proposing changes to the Medicare Shared Savings Program quality performance standard and quality reporting requirements for performance years beginning on Jan. 1, 2021.

These changes will align with Meaningful Measures, reduce reporting burden and focus on patient outcomes, the agency said.

For performance year 2020, CMS wants to provide automatic full credit for CAHPS patient experience of care surveys.

The proposed Physician Fee Schedule rule also clarifies payment policies for remote patient monitoring services. The rule clarifies that RPM services are considered to be evaluation and management (E/M) services and that only physicians and non-physician providers who are eligible to furnish E/M services may bill RPM services.

Clinicians also may provide RPM services to patients with acute conditions as well as patients with chronic conditions, according to the proposed rule.

According to the proposed changes, the MIPS performance threshold would increase to 50 points in 2021, from 45 points in 2020. Cost would be weighted 5% more, from 15% to 20%.

As clinicians across the country continue to respond to the COVID-19 pandemic, the agency said it recognizes that the most important priority right now is ensuring patients are getting the care they need.

CMS will delay implementation of the MIPS value pathways program until 2022, but begin a new MIPS alternative payment model pathway called APP next year.

CMS is also seeking comment on an alternative scoring methodology approach under the extreme and uncontrollable circumstances for performance year 2020. 

During the public health emergency CMS adopted a policy revising the definition of direct supervision to include virtual presence of the supervising physician or practitioner using real-time video communications technology. Under the proposed rule, direct supervision could be provided using real-time, interactive audio and video technology through Dec. 31, 2021.