2021 Medicare Payment Rule Finalizes Steep 10% Conversion Factor Cut – Contact Your Member of Congress to Prevent CMS from Implementing
The American Medical Association has developed a comprehensive summary of the 2021 Medicare physician payment rule. As has been widely reported, while the payment rule incorporates some long overdue increases in E&M codes, statutory budget neutrality rules are forcing a 10.2% cut in the conversion factor.
Therefore, MSSNY has been working together with numerous state medical associations and the AMA in support of Congressional legislation to prevent the conversion factor cut (while urging the E&M changes to go forward). You can join us in these efforts by sending a letter from here.
From the AMA Summary – CY 2021 Physician Fee Schedule Ratesetting and Conversion Factor
- The final CY 2021 Medicare Physician Fee Schedule (PFS) conversion factor is $32.4085, which represents a 10.2% reduction from the CY 2020 conversion factor of $36.09.
- Similarly, the final CY 2021 anesthesia conversion factor is $20.0547, down 9.61% from the CY 2020 anesthesia conversion factor of $22.20.
- The most widespread specialty impacts of the relative value unit (RVU) changes are generally related to the changes to RVUs for specific services resulting from the E/M office visit increases and other changes made by CMS. The AMA/Specialty Society RVS Update Committee’s (RUC) recommendations account for a 5.5% reduction to the conversion factor. The remaining spending increases and resulting conversion factor reduction is attributed to various CMS proposals to increase valuation for specific services, including the E/M visits and the new G2211 visit complexity add-on code.
- E/M visits billed using CPT codes comprise approximately 45% of allowed charges for PFS services. Office and outpatient E/M visits comprise approximately 25% of allowed charges for PFS services.
- There is considerable variability within the specialties of the Federation in terms of E/M level of visits and volume. Physicians such as family practitioners who do not provide procedural interventions or diagnostic tests have most of their allowed charges from E/M visits. Therefore, these practitioners and other primary care providers should expect to see increases for their E/M visits.
- CMS finalized Current Procedural Terminology® (CPT) descriptors, guidelines, and payment rates effective on January 1, 2021, which are a significant modification to the coding, documentation, and payment of E/M services for office and outpatient visits. In the final rule, CMS retained five levels of coding for established patients, reduced to four levels for new patients, and revised code definitions. CMS revalued services analogous to office outpatient E/M visits.
Notes from Governor Cuomo’s Wednesday Briefing
– Day 284
– Statewide positivity rate without micro-clusters: 4.86%
– Statewide positivity rate with micro-clusters: 5.44%
– Micro-cluster positivity rate: 7.08%
– 95 Deaths
– 194,595 tests conducted yesterday
– 4,993 hospitalizations (+158)
– 952 ICU patients (+46)
– 521 intubations (+28)
– Gov reiterates his plan to manage hospitals via a surge and flex method
– Gov plans to meet with hospital administrators today
– Gov will add new factors to the plan to slow spread on Friday
– Mayor Bill de Blasio and AFL-CIO President Mario Cilento joined the Gov during the briefing
– de Blasio emphasized the importance of federal aid
– Cilento thanked the Gov for leading the call for federal aid
– Cilento warned that without federal aid, the unemployment rate
will go up and businesses and schools will suffer
General Vaccine Information:
– Short-term plans for the state:
– release a public education campaign to battle skepticism
– conduct outreach to minority communities
– expedite distribution and administration beginning in the next few days
– Pfizer’s vaccine is expected to be approved by the FDA tomorrow
– If the FDA approves, 6 million doses will be available, with half
being shipped immediately and a second shipment 21 days later
– NY expects to receive 170,000 doses as soon as this weekend
– Priorities for vaccines are as follows:
– 1. Nursing home residents, then nursing home staff, followed by high risk hospital workers
– 2. By week 2, all high risk staff will have access to a vaccine
– 3. All long term and congregate care staff, EMT
– 4. Essential workers and general population
– There are 90 regional distribution centers for the vaccine in NY
– 90 locations across the state will receive enough doses for 90,000 hospital staff
– Estimated allocation by region:
– North Country: 3,700
– Finger Lakes: 11,150
– Mohawk Valley: 4,200
– Western NY: 14,500
– Central NY: 6,400
– Capital Region: 7,850
– Southern Tier: 4,500
– Mid-Hudson: 19,200
– NYC: 72,000
– Long Island: 26,500
– NYS National Guard has been selected to be part of a Federal pilot program to be part of the limited Pfizer COVID-19 vaccine distribution for military personnel
– The CDC agreed that no individual identifying data will be shared with the federal government, protecting undocumented individuals
– On community sites for vaccination, when will the Gov roll out a list for vaccination locations
– Gov refers to the list of priorities for vaccination
– The general public might be eligible for vaccinations by late January
– Why hasn’t the state released more data on outbreaks?
– Gov: contact tracing data comes from local governments
– Gov will release more contact tracing data on Friday
– On limitations for indoor dining, is there a nexus between COVID and indoor dining?
– Gov says spread from indoor dining is not as bad as it was due to the current restrictions in place
– Indoor dining qualifies as a type of gathering place, which is still a source of spread
Bi-Partisan Letter Sent to Senate Leaders Urging Congress to Pass Legislation to Prevent Physician Medicare Cuts
MSSNY released a statement to the press on Tuesday thanking Senator Gillibrand for joining the bi-partisan letter signed by 50 Senators to prevent the huge Medicare cuts:
“MSSNY thanks Senator Kirsten Gillibrand for joining on to a bi-partisan letter to US Senate Majority Leader McConnell and US Senate Minority Leader Schumer urging Congress to pass legislation to help prevent steep cuts to Medicare physician payment for 2021 that would undoubtedly cause significant access to care issues for our seniors and exacerbate already enormous practice challenges arising from the pandemic. The cuts are the result of a statutory ‘budget neutrality’ rule that requires that any increases in Medicare payments must be offset by corresponding decreases…read full press release here.
Crain’s New York: MSSNY Press Statement
MEDICARE CUTS: The Medical Society of the State of New York said in a statement issued Tuesday that it applauds Senator Kirsten Gillibrand for joining a bi-partisan letter to Senate leaders urging Congress to pass legislation to prevent physician Medicare cuts. “The cuts are the result of a statutory ‘budget neutrality’ rule that requires that any increases in Medicare payments must be offset by corresponding decreases,” said Dr. Bonnie Litvack, president of the medical society, in a statement. “The letter notes, importantly, the Senators’ support for other changes to the 2021 Medicare payment rule that would provide long overdue payment increases for primary care and other office-based services.” (Crain’s, 12/9)
Discounts for MSSNY Members on Grocery Delivery and Meal Services
The COVID-19 pandemic has increased demand for food delivery services. MSSNY has numerous grocery delivery and meal service discount offers available for members through our member benefit partner, Abenity. Click on the links below to access the discounts. Haven’t signed up for Abenity yet? See story below for easy instructions.
- Blue Apron: http://mssny.abenity.com/perks/offer/1:648116
- Hello Fresh: https://mssny.abenity.com/perks/offer/2:12823570
- Home Chef: http://mssny.abenity.com/perks/offer/1:84302
- Shipt: http://mssny.abenity.com/perks/offer/1:84686
- Gourmet Appetite: http://mssny.abenity.com/perks/offer/1:85244
- Farm Fresh to You: http://mssny.abenity.com/perks/offer/8:327
- Sun Basket: http://mssny.abenity.com/perks/offer/958:12857389
- Freshly: http://mssny.abenity.com/perks/offer/958:12857396
- The Dinner Daily: http://mssny.abenity.com/perks/offer/8:203
Are You Registered for MSSNY’s Member Perks Program? Sign Up for Abenity Now
MSSNY’s Abenity App provides members with exclusive perks and over $4,500 in savings on everything from grocery delivery and meal delivery services to mortgage savings and auto care.
REGISTER & LOG IN:
- Click on the following link: http://mssny.abenity.com
- Create a unique user name and password
- Visit the App Store and download the Abenity App
- Begin Saving!
Attention Medical Students: Join Webinar, “Medical Student and Physician Wellness in the Present Era”
Join MSSNY, the AMA, and our partners for an exclusive conversation with the Immediate Past President of the American Medical Association, Dr. Patrice Harris. Dr. Harris is a psychiatrist from Atlanta and is one of the leading voices in the nation on the topic of physician and medical student wellness. Please click here to register for the webinar.
Interested in Learning Social Media?
MSSNY is planning an upcoming Zoom “Social Media in Medicine” presentation for physician members interested in using social media. If interested in participating, please contact firstname.lastname@example.org for more information.
CMS Finalizes Major Changes to E/M Coding and Documentation Requirements in 2021 – Will You Be Ready?
Join Garfunkel Health Advisors, Inc. to prepare you for the biggest change in decades to the documentation and coding guidelines for Evaluation and Management (E/M) services, which go into effect on January 1, 2021.
Who this will affect: The Centers for Medicare and Medicaid Services (CMS) new E/M coding changes will affect every provider that bills for office and outpatient visits, including physicians, NPPs, practice plans, hospitals, HIT companies, health plans and health systems.
Why you need to attend: It is critical that the provider community understand the full impact of these changes, how they will affect your reimbursement and how to train your providers and staff to ensure compliance. This webinar will provide practical guidance on the most important aspects of the new rules and discuss best practices to reduce your audit and compliance risks.
“PTSD in Returning Veterans” Webinar
The Medical Society of the State of New York is hosting a Continuing Medical Education (CME) program entitled Veterans Matters: PTSD in Returning Veterans live webinar on Tuesday, January 26, 2020 at 7:30 am.
When: January 26, 2020 at 7:30 am
Faculty: Frank Dowling, MD
- Identify diagnostic criteria for PTSD
- Discuss medical and psychiatric comorbidities of military related PSTD
- Discuss evidence-based treatment modalities for PTSD including medications and psychotherapy
- Discuss strategies to help veterans overcome stigma to seek and accept treatment for military-related trauma
For more information, contact Jangmu Sherpa at email@example.com or call (518) 465-8085
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Building includes 3 exam rooms, waiting area. Please respond by calling 718-987-3300 or email firstname.lastname@example.org