Expanded telehealth, scope of practice
The 2021 Medicare physician fee schedule permanently allows Medicare providers to use telehealth to carry out home visits for so-called evaluation and management services and some visits for people with cognitive impairments. It also temporarily continues telehealth services for emergency department visits and other services with an eye toward making them permanent.
“Telehealth has long been a priority for the Trump administration, which is why we started paying for short virtual visits in rural areas long before the pandemic struck. But the pandemic accentuated just how transformative it could be,” CMS Administrator Seema Verma said in a statement.
According to CMS, more than 24.5 million of Medicare’s
63 million beneficiaries and enrollees received a Medicare telemedicine service during the public health emergency. The agency expanded the telehealth services that rural enrollees can receive
“This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care.” Seema Verma, CMS administrator
at healthcare facilities. During a call with reporters, Verma reiterated that Congress needs to change federal law to permanently allow nonrural beneficiaries to receive telehealth benefits or for Medicare beneficiaries to receive telehealth services at home.
The agency also sewed up several expansions to providers’ scopes of practice. Nurse practitioners, physician assistants and other clinicians who aren’t physicians can supervise diagnostic testing if state laws allow it starting next year. CMS made it clear that providers can bill Medicare for professional services delivered by pharmacists. Physician groups, including the American Medical Association, have historically lobbied against expanding scope of practice for caregivers who aren’t physicians.
Beyond that, physician practices will see their payments cut as the agency lowered the fee schedule’s conversion factor by 10.2%. It also made several changes to evaluation and management services and codes, including increases in their relative value and changes to coding criteria. Those moves could help clinicians who deliver a lot of those services, but proceduralists will probably see their revenue decline.
“This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care,” Verma said.
But providers who will see payment cuts weren’t satisfied. “The 10% decrease to the conversion factor and resulting reimbursement cuts to
many specialties is deeply troubling during a time when COVID-19 cases are skyrocketing and practices are scrambling to stay financially viable,” Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, said in a statement.
Providers are struggling to predict how the payment changes will shake out because nobody knows how the coronavirus outbreak will affect their practices over the next two quarters.