February 28, 2021

ISASS Comments on the 2021 Final Outpatient Prospective Payment System/Ambulatory Surgical Center Rule

ISASS Comments on the 2021 Final Outpatient Prospective Payment System/Ambulatory Surgical Center Rule On December 2, 2020, CMS finalized policy changes for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules. In this final rule, CMS indicated they will be eliminating the inpatient only (IPO) list of 1,700 procedures for which Medicare will only pay when performed in the hospital inpatient setting over a 3-year transitional period, beginning with some 300 primarily musculoskeletal-related services. The IPO list will be completely phased out by the 2024 calendar year. This change will make these procedures eligible to be paid by Medicare when furnished in the hospital outpatient setting when outpatient care is appropriate, as well as continuing to […]
February 28, 2021

CMS Provides Update to 2021 Final Physician Fee Schedule Rule

CMS Provides Update to 2021 Final Physician Fee Schedule Rule On December 27, 2020, CMS finalized updated payment rates under its Medicare Physician Fee Schedule Rule for the 2021 calendar year (CY). These updates were made to reflect the Omnibus COVID-19 Relief Legislation passed by the U.S. Congress on December 27, 2020. Several items were included in the legislation that reduced the 11% conversion factor to around 4%. As a result, many procedures that would have otherwise had significant decreases in Medicare reimbursement will have either small decreases or small increases. The new physician fee schedule conversion factor for 2021 is $34.89. That is higher than the conversion factor finalized in the rule released in December, but it is 3.3% less than […]
January 28, 2021

Congress Considers Legislation to Offset Physician Fee Schedule Budget Neutrality Impacts

Congress Considers Legislation to Offset Physician Fee Schedule Budget Neutrality Impacts As physicians continue to battle the worsening COVID-19 pandemic, the last thing they should have to worry about is cuts to their Medicare payments. Unfortunately, without Congressional action before January 1, 2021, that nightmare scenario will become reality. Under current law, CMS is required to make budget neutrality adjustments to the Medicare physician payment schedule whenever changes in relative value units (RVUs) generates a payment increase or decrease by $200 million. As a result, significant increases in RVUs for office evaluation and management (E/M) services finalized by CMS this month and scheduled to take effect in 2021 will lead to a wide range of payment increases and decreases based […]
January 26, 2021

COVID-19 Vaccine Resources Released

COVID-19 Vaccine Resources Released CMS and the American Medical Association (AMA) have both developed resources to support efforts to communicate about the COVID-19 vaccine. Please see links and information below if you are interested in providing information and updates to patients and staff. During the COVID-19 public health emergency, Medicare will cover and pay for the administration of the vaccine (when furnished consistent with the emergency use authorization). Physicians should review Medicare payment and Healthcare Common Procedure Coding System (HCPCS) Level I Common Procedural Terminology (CPT) code structure for specific COVID-19 vaccine information. They should only bill for the vaccine administration codes when submitting claims to Medicare; vaccine product codes should not be included when vaccines are free. CMS Information: CMS COVID-19 […]