An 11th-hour COVID-19 relief package was approved by both houses of Congress a few days before Christmas and signed into law by President Trump a few days after. The legislation known as Coronavirus Relief & Omnibus Agreement, second in size only to the CARES Act passed last spring in the early days of the pandemic, provides wide-ranging relief to multiple sectors throughout the country, including physicians.
Updates to the 2021 Medicare Physicians Fee Schedule
For physicians, several different provisions should offer both long-term and short-term financial relief, especially changes to the 2021 Medicare Physician Fee Schedule, which included steep cuts for many specialties because of changes to the office and outpatient evaluation and management (E/M) coding and reimbursement. Those Medicare changes include:
- Three-year delay of a new add-on code for “inherent complexity” (G2211) that providers could bill in addition to office and outpatient E/M visits.
- Adding 3.75 percent to the Medicare conversion factor for 2021 to help offset the steep cuts that will still exist because of changes to the office and outpatient E/M visits.
These two increases together resulted in a recalculated conversion factor of $34.89 for 2021, up from the originally published $32.41 and only around a 3 percent decrease (rather than approximately 10 percent) from the 2020 PFS conversion factor of $36.09.
The recent legislation also mandates continuing the temporary suspension of the 2 percent Medicare sequestration for another three months.
Other Funding Provisions
In addition to the changes to the Medicare Fee Schedule, physicians also will benefit from the additional $3 billion in provider relief and the $285 billion in Paycheck Protection Program (PPP) funds.
Indirectly, physicians also should benefit from loans for small businesses, the establishment of a national COVID-19 testing and contact tracing system, and funds for health-related expenses of state and local governments, including help distributing vaccines. As well, staff and patients will receive a boost from enhanced unemployment benefits and direct payments up to $600 from the federal government.
Surprise Billing Legislation
After years of negotiation and proposed legislation, the last-minute funding bill also included a ban on surprise billing, which means patients will be held harmless for any bills for out-of-network emergency or air ambulance services and many out-of-network (OON) services provided at in-network facilities.
Patients will be responsible for the equivalent of in-network cost sharing in those instances. Amounts above that will be worked out between payers and providers, with disputes going to third-party arbitration, an option physician groups lobbied for. The bill also prohibits arbiters from considering Medicare and Medicaid rates or providers’ billed charges when deliberating OON bills. However, arbiters will be instructed to take into account the median in-network rate for the service.
In some non-emergency situations, OON providers and facilities will be able to bill patients for OON services beyond the in-network rate if specified notice and consent requirements are met.
For more information about the most recent COVID-19 Relief package, review the following resources:
- Pelosi, Schumer Joint Statement on Coronavirus Relief & Omnibus Agreement
- Provider-friendly surprise billing fix, more funds for hospitals in year-end spending bill from Healthcare Dive
- Congress OKs COVID-19 package that includes surprise billing fix, more provider relief money from Fierce Healthcare
- Federal COVID Relief Bill passed by Congress – December 2020 from The National Law Review
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