Alex Kirkland joins Mark to discuss changes to the Medicare Physician Fee Schedule (MPFS) final rule. On December 27, 2020, Congress passed and the President signed into law the Consolidated Appropriations Act. The stimulus bill provided temporary relief by partially mitigating cuts to the conversion factor in 2021.

 

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Episode Synopsis

Many payers use the Physician Fee Schedule (PFS) as the foundation for their rates and how they set their conversion factor. Although the stimulus bill only affects Medicare reimbursement for physician professional services, the impact will extend beyond Medicare. The stimulus package provides support only during 2021, so the full 10% cut to the conversion factor is still expected in 2022.

Medical groups need to analyze their financial impact through a CPT level revenue and wRVU compensation analysis. The important concept is compensation increases should not outpace reimbursement, meaning you can’t afford to pay more than your revenue allows.

There are also fair market value (FMV) and commercially reasonable (CR) implications and issues to consider. The new regulations state that a hospital may not value a physician’s services at a higher rate than a private equity investor or another physician practice.

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Extras

Estimate the Financial Impact of 2021 E/M Coding Changes

Episode 82: How the MPFS Final Rule Impacts Medical Practices (and What to Do about It)

Webinar Replay: 2021 E/M Coding Changes: What Healthcare Professionals Need to Know