Highlights of CMS Issued Final Rule 2021 for MPFS & QPP MIPS
CMS (Centers for Medicare and Medicaid Services) issued the Final Rule for 2021 MPFS (Medicare Physician Fee Schedule). The updates also include changes for the QPP MIPS - a quality healthcare incentive program for Medicare rates under Part B claims.
The Rise of Telehealth
Where we can see other significant changes in the payment program, CMS also planned to promote the use of telehealth services. This step is considered to accommodate the
current PHE (Public Health Emergency) stating the E/M (evaluation and management) documentation for MIPS incentives.
COVID Delayed the Implementation of MVPs (MIPS Value Pathways)
The introduction of MVPs was expected to include in MIPS 2021. However, the pandemic disturbed even the regular operations of the healthcare industry, so the smooth delivery of the MVPs could not be possible this year. So, this framework is delayed until the next year or the year later.
New Interim Final Rules IFRs)
CMS also introduced new interim final rules in the list.
Coding and Payment for 'Virtual Check-In' Services
Coding and Payment for PPE (Personal Protective Equipment)
These new additions are described as:
Instructions for Virtual Check-Ins
CMS has established HCPCS (Healthcare Common Procedure Coding System) code - G2252 to report extended audio-only medical assessment services for 11-20 minutes for QPP MIPS.
Moreover, it is to remember that service coverage is only limited to established patients. According to the facts, the rendered services may not originate from a related E/M service provided within the last seven days. Nor can it leads to an E/M service for the upcoming 24 hours or next available appointment at the earliest.
Instructions for PPE
Now, QPP MIPS eligible clinicians can use CPT code – 99072 to report PPE supplies during a public health emergency. CMS has also voted for the price increases in this regard.
Although these supplies are considered "bundled," CMS will support the payment increment for the rendered services that include supplies.
What CMS Says about the Decrement of CF (Conversion Factor) for Physician Fee Schedule?
For MIPS 2021, CMS has planned to lower down the conversion factor by 10.2 percent. It came down from $36.0896 in 2020 to $32.4085 in 2021.
This negative payment adjustment rate results from budget neutrality adjustment that accounts for changes in (RVUs) relative value units. The changes are driven by updates in the E/M services and other proposed work.
In order to restrict the reduction of conversion rate, now we require congressional rule. Two rules are established in this regard.
Reps. Michael Burgess (R-Texas) and Bobby Rush (D-Ill.) - H.R. 8505
It provides a one-year waiver of budget neutrality adjustments for the QPP MIPS physician fee schedule.
Reps. Ami Bera (D-Calif.) and Larry Bucshon (R-Ind.) - H.R. 8702
It accounts healthcare providers harmless from negative payment adjustment and offers them an additional payment that levels up reimbursement up to the QPP MIPS 2020 physician fee schedule for two years.
Conclusion
The changes for MIPS 2021 will give a clear way to the upset healthcare system amidst corona. Of course, it will also help eligible clinicians and MIPS consultants with an effective strategy to target incentives and bonuses.