Industry Responds to CMS PFS Final Rule

The CY 2021 Medicare Physician Fee Schedule Final Rule was placed on display at the Federal Register on December 2, 2020. This final 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.

This final rule updates policies affecting the calculation of payment rates and includes misvalued codes. It also adds services to the telehealth list including a third temporary category for services added under the PHE, as well as certain other revisions to telehealth services. It also addresses direct supervision as it relates to interactive technology, payment for teaching physicians, and provides clarification on medical record documentation. Additionally, this final rule includes several regulatory actions regarding professional scope of practice for certain non-physician practitioners. This final rule also provides clarification to the implementation of Section 2005 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which creates a new Medicare Part B benefit for Opioid Treatment Programs. The calendar year (CY) 2021 PFS final rule is one of several rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.

The American Telemedicine Association
In response to the Centers for Medicare & Medicaid Services (CMS) annual Physician Fee Schedule (PFS) final rule issued on December 1, 2020, permanently expanding Medicare telehealth services, the American Telemedicine Association (ATA) (@AmericanTelemed) issued the following statement:

“CMS got a lot right in this final rule, including making a range of telehealth services permanently available to Medicare beneficiaries. Our fingers are crossed that many of the temporary telehealth services added to the Medicare list during the public health emergency will also be made permanent,” said Ann Mond Johnson, CEO, the ATA. “This final rule is yet another clear indication that telehealth has become a permanent part of our healthcare system and we applaud the administration for its leadership to ensure our citizens have had increased access to vital telehealth services in response to COVID-19.”

Association of American Medical Colleges (@AAMCtoday) Chief Health Care Officer Janis M. Orlowski, MD, issued the following statement on the Centers for Medicare and Medicaid Services (CMS) annual Physician Fee Schedule final rule:

“While the AAMC appreciates CMS’ commitment to restructuring and increasing payment for office-based evaluation and management (E/M) codes by implementing significant changes for 2021, we are dismayed to see that the final rule continues to include sizable cuts in payment for other services due to budget neutrality requirements. We are deeply concerned that these devastating cuts to physicians, physician practices, and other health care professionals are coming at a time when they are serving on the front lines of the COVID-19 pandemic and caring for patients. Cuts to emergency room and intensive care unit physician payments during this pandemic is especially concerning. The AAMC will continue to work with other stakeholders and policymakers to find a responsible solution that maintains the E/M increases while also responsibly addressing these problematic cuts. Read entire statement.

Joint Statement from E&M Coalition on 2021 Medicare Physician Fee Schedule Final Rule: We, the undersigned organizations representing cognitive specialty and primary care physicians release the following statement regarding the Centers for Medicare and Medicaid Services (CMS) 2021 Medicare Physician Fee Schedule final rule (CMS-1734-F) which was released last week.

“As organizations collectively representing hundreds of thousands of physicians currently on the frontlines treating patients during the COVID-19 pandemic, we applaud CMS for moving forward with implementing the AMA-RUC recommended increases to the values for traditionally undervalued outpatient Evaluation and Management services on January 1. Our members provide comprehensive primary and specialty care, mental health and/or preventive care to millions of Medicare beneficiaries, and these long-overdue payment changes are critical for preserving patients’ access to these critical services. We are pleased to see that in finalizing the 2021 Medicare Physician Fee Schedule the agency decided to move forward without delay given how important these increases are, especially during a global pandemic. Read the entire statement.

Endocrine Society
Endocrine Society applauds Medicare Physician Fee Schedule final rule – We, the undersigned organizations representing cognitive specialty and primary care physicians released the following statement regarding the Centers for Medicare and Medicaid Services (CMS) 2021 Medicare Physician Fee Schedule final rule (CMS-1734-F) which was released last week. Read entire statement.

College of American Pathologists (CAP)
The College of American Pathologists (CAP) President Patrick Godbey, MD, FCAP issued the following statement following the release of the final 2021 Medicare Physician Fee Schedule on December 1:

“The CAP strongly objects to the 9% Medicare cuts to pathologists, which the Centers for Medicare & Medicaid Services (CMS) published in the final 2021 Physician Fee Schedule and urges Congress to act quickly to stop these cuts prior to their scheduled January 1 implementation. Due to the ongoing public health emergency related to the COVID-19 pandemic, it is especially important Congress take steps to alleviate the CMS’s looming 2021 payment reductions to all non-evaluation and management (E/M) services.” Read the entire statement.

MGMA statement on the 2021 Physician Fee Schedule Final Rule – While MGMA is appreciative of streamlined documentation policies and payment increases to physicians that primarily deliver office/outpatient E/M services, the 10% decrease to the conversion factor and resulting reimbursement cuts to many specialties is deeply troubling during a time when COVID-19 cases are skyrocketing and practices are scrambling to stay financially viable. We are disappointed that CMS decided to not provide the stability that physician practices require to meet patient needs during this unprecedented public health emergency.

American College of Radiology
Congress Must Act to Fortify Healthcare System and Protect Access to Care – The final 2021 Medicare Physician Fee Schedule (MPFS) issued today by the Centers for Medicare & Medicaid Services (CMS) failed to provide relief from a significant shift in physician and non-physician payments expected to take effect on January 1, 2021. Thousands of comments submitted by providers, patients, and Members of Congress highlighted the importance of mitigating payment cuts associated with budget neutrality requirements triggered by higher payment and modified reporting requirements for evaluation and management (E/M) services.

Due to CMS’s unresponsiveness to address these concerns, organizations representing more than 1 million physicians and nonphysician health care providers across the United States urge Congress to include legislation in any year-end package to prevent these arbitrary Medicare cuts in order to protect patient access to medically necessary services. Read entire statement.