Please Take This Opportunity to Contact Your Members of Congress and Help Us Prevent Drastic Medicare Physician Fee Cuts to Ophthalmology
The Centers for Medicare and Medicaid Services (CMS) recently released its proposed 2021 Medicare Physician Fee Schedule rule. As a result of the restructuring and revaluing of Evaluation and Management (E/M) codes and other payment changes, in addition to CMS refusing to increase the post-op E/M visits in 10- and 90-day global surgical codes, ophthalmology is expected to get a 6% reduction in overall reimbursement effective January 1, 2021. This is despite the objections and warnings from ASCRS and the medical specialty community on the impact this would have on physician practices already struggling from the negative impacts of the COVID-19 pandemic.
For CMS to offset this increased spending and due to budget neutrality rules, the conversion factor will be reduced by 10.6% – a $3.83 decrease from the 2020 conversion factor. Therefore, the estimated conversation factor for 2021 will be $32.26, the lowest it has been since 1993.
The impact of this and other changes results in a significant reduction to cataract surgery reimbursement (66984) by 9% from the 2020 rate of $557.58 to $505.84. Other ophthalmic codes are also negatively impacted. These cuts will have a devasting impact on ophthalmology and have the potential to reduce patients’ access to surgical care. An excel spreadsheet comparing all CPT code CY 2020 RVUs to the proposed CY 2021 RVUs for your reference is included here.
To prevent these drastic payment cuts and preserve access to care for patients, Congress must act!
ASCRS is working with the Surgical Coalition to pressure Congress to:
- Waive Medicare’s budget neutrality requirements, which allow the implementation of the payment increases for the stand-alone E/M services and the establishment of add-on codes but avoid the reimbursement cuts to other physician services required to offset these costs.
- Require CMS to apply the increased E/M payment to the post-op visits included in the 10- and 90-day global surgical services.
To help us to get Congress to act, it is imperative that members of Congress hear from you! They need to hear how the proposed 2021 Medicare Physician Fee Schedule Rule jeopardizes patient care and threatens the continued viability of your practice.
Act Now to Support Our Efforts.
- Call Your Members of Congress Today!
- Urge your representatives and senators to preserve patient access to surgical care and stop drastic payments cuts for surgical services.
- Call 202-224-3121 and ask to be connected to your elected officials’ offices.
- Use our talking points to incorporate in your discussions
- Use the ASCRS eye Contact Grassroots Advocacy Tool to tell your elected officials to act to prevent Medicare physician reimbursement cuts for surgical services.
HHS Opening Up Provider Relief Fund for Additional Payments
Recently, the Department of Health and Human Services (HHS) announced that certain Medicare providers would have another opportunity to receive additional payments from the Provider Relief Fund. Specifically, these are providers who previously missed the June 3, 2020 deadline to apply for additional funding equal to 2% of their total patient care revenue from the Phase I General Distribution. In addition, certain providers who had a change in ownership, will also have an opportunity to apply for financial relief.
On August 10, HHS announced that these eligible providers may now submit their application by August 28, 2020, which aligns with the extended deadline for other eligible Phase 2 providers.
Representative Bobby Rush (D-IL) and 92 Bipartisan House Members Urge Leadership to Prevent Medicare Physician Payment Cuts
On August 11, 92 bipartisan members of the House of Representatives joined Representative Bobby Rush in a letter to House leadership expressing support for increases in Evaluation and Management Services (E/M) but requesting that any upcoming legislation moving through the house include a provision to waive budget neutrality for two years in order to prevent significant reductions in reimbursement for specialists in order to pay for the increases. The letter also suggests a study on the impact of the COVID-19 pandemic on rural and underserved areas and the impact failing to waive budget neutrality would have on providers.
Senate Adjourns Until September; No Agreement on Next COVID-19 Package
The Senate has now recessed and will not return until September 8 unless there is an agreement between the Democratic leaders and the administration. Those negotiations have broken down and as of press time, have not resumed. If an agreement is reached, senators will have 24 hours’ notice to return. The House already left and will not return until September 14 unless there is an agreement. Both parties are scheduled to hold their conventions virtually this month.
Last weekend, the president released a slate of executive actions which included a payroll tax referral, jobless benefits, an eviction moratorium extension, and relief for student borrowers. However, those actions have been criticized by Democrats and some Republicans as an infringement on Congress’s power of the purse and could face legal challenges.
Physician Compare Preview Period Ending on August 20, 2020
The Physician Compare Preview Period ends on August 20, 2020 at 8:00 PM ET. If you have not already previewed your information, you should take this opportunity to preview your 2018 Quality Payment Program performance information before it is publicly reported.
You can access the secured measure preview site through the Quality Payment Program website.
Review the resource below on how to preview your information:
For additional assistance with accessing the Quality Payment Program website, or obtaining your EIDM user role, contact the Quality Payment Program service center at [email protected].
To learn more about the 2018 Quality Payment Program performance information that is available for preview, as well as the 2017 clinician utilization data that will be added to the Downloadable Database, download these documents from the Physician Compare Initiative page:
