As part of the COVID relief and end-of-year package, Congress offset the majority of cut to Medicare reimbursement that was expected to take place on January 1, 2021. CMS just published the new Physician Fee Schedule (PFS) conversion factor—which converts code values into dollar amounts—based on that legislation, and instead of that original 10.2 percent cut, a service performed in 2021 will now be paid only 3.3 percent less than what it was paid in 2020. However, because ACEP was able to secure that increase in the code values by CMS for our ED E/M codes, you will likely not see any of that decrease. In fact, you may actually see an increase in your Medicare payments overall (and remember, many private payors base their payments on Medicare rates).
This is the result of years of work ACEP has done to increase the value of certain EM codes, described below.
One of the leading legislative and regulatory priorities for ACEP has been preventing the cuts included in the final Medicare PFS for 2021, which were set to take place on January 1. This regulation from the Centers for Medicare & Medicaid Services (CMS) sets Medicare payment rates for the coming calendar year (CY), and often serves as the basis for which many private payors set their reimbursement rates. You can find a high-level summary of the final rule here.
ACEP knew ahead of time that CMS was planning on including these cuts in the PFS and took action. When CMS announced last year that it was seeking to revalue the office and outpatient evaluation and management (E/M) codes for CY 2021, ACEP advocated strongly for corresponding increases for the ED E/M codes—the most commonly billed codes for emergency medicine. These efforts built on our advocacy to the American Medical Association’s RVS Update Committee (RUC). ACEP also provided data and a solid policy argument to directly to CMS and the White House to strengthen our case. That advocacy paid off, and CMS adopted our specific code values for the ED E/M codes, which increases emergency medicine reimbursement by approximately 2 percent for CY 2021.
Unfortunately, a large increase to primary care E/M codes that CMS finalized last year also takes effect in 2021. Because of the existing budget neutrality requirement under the Medicare PFS, any increases in the value of one code means a corresponding decrease in the value of all other codes. Thus, in the final PFS regulation, CMS cut the conversion factor, which changes code values into a dollar amount, by 10 percent in CY 2021, one of the largest cuts in 25 years. Essentially every specialty got a “haircut,” reducing some codes’ increases and exacerbating other’s decreases.
ACEP’s advocacy for the increase for the ED E/M codes staved off a bigger reduction in value. Basically, ACEP got you a raise, but CMS budget neutrality rules cancelled it out. Overall, instead of a cut closer to 10 percent, CMS estimated that the cut to emergency medicine would be 6 percent.
A projected 6 percent cut to emergency medicine in 2021 was unacceptable. ACEP worked closely with legislators and other physician and non-physician groups affected by the rule to push for a solution that protected physicians from such drastic cuts–especially when many emergency physicians still face unprecedented financial hardships and instability due to the COVID-19 pandemic.
In the year-end package, Congress instituted the following two provisions which will reduce the cut to emergency medicine:
These two changes—in addition to the increases in the ED E/M codes that ACEP secured—means that instead of a 6 percent cut on January 1, emergency physicians will see at worst a 2 percent reduction in reimbursement. But depending on their code mix, some may even see an overall positive increase. In other words, the raise that ACEP helped get for emergency physicians in the PFS may actually now come to fruition.