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COVID-19, Compensation and Quality: 2021 Physician Fee Schedule Proposed Rule

August 26, 2020

COVID-19, Compensation and Quality: 2021 Physician Fee Schedule Proposed Rule

HOT OFF THE PRESS! The 2021 Physician Fee Schedule (PFS) Proposed Rule was released on August 3, 2020. Included in the Rule are updates to Part B reimbursement policies and Quality Payment Program (QPP). Some of the highlights from the Rule are listed below:

  • Physician Fee Schedule 
    • Reduces the conversion factor by $3.83 for a new factor of $36.09 
    • Changes to: covered services reimbursable via telehealth, supervision requirements, frequency limits of certain visits, and updates to NPP and pharmacists ability to provide services
    • Clarification and updates to Remote Patient Monitoring coverage
    • Proposes that students can document in the medical record as long as the entry is reviewed by the billing provider
  • Changes to E/M coding and documentation for office visit coding
    • Eliminating code 99201
    • Allowing time and medical decision making (MDM) to determine level of service
    • New "prolonged service" code (99xxx)
    • New add-on code for “complex patients” (GPC1X)
    • Payment for non-face-to-face time the same day as an office visit (99358)
    • Social determinants of health will be factors in MDM
  • Quality Payment Program 
    • Changing:
      • Category weights
        • Quality 40% (from 45%)
        • Cost 20% (from 15%)
        • Promoting Interoperability 25% (no change)
        • Improvement Activities 15% (no change)
      • Threshold score to 50 points (from 45 points)
    • Refining the guidelines for MIPS Value Pathways
    • Creating an APM Performance Pathway (APP) which will lessen MIPS-APM participants’ individual reporting burdens
    • Removal of the CMS Web Interface as a reporting option
    • Adding new Quality measures 
    • Increasing the 
      • PDMP measure bonus points to 10 
      • Complex patient bonus points to 10
    • Providing targeted review options for APM participants
    • Changing specific to MSSP reporting and scoring

These resources are provided to you through Practice Solutions, a program created to help LAMMICO insureds mitigate their malpractice risk as well as navigate the regulatory and financial burdens on physicians and their practices. Contact Natalie B. Cohen at 504.841.2727. 

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