We Need Your Help Now to Prevent Drastic Medicare Physician Fee Cuts to Ophthalmology! Please Contact Your Members of Congress Today!
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 conversion 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 devastating impact on ophthalmology and have the potential to reduce patients’ access to surgical care.
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:
- Stop the proposed Medicare physician payment cuts to specialties, like ophthalmology, which are effective January 1, 2021
- 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! Congress will be returning to Washington, D.C. after the Labor Day holiday. 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.
CMS Releases Proposed Rule to Expedite and Clarify Medicare Coverage for Innovative Technology
On August 31, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Coverage of Innovative Technology (MCIT) proposed rule to provide an expedited timeline for Medicare coverage for innovative technology that have U.S. Food & Drug Administration (FDA) market authorization. It would create a new, accelerated Medicare coverage process for innovative products that the FDA deems “breakthrough,” which FDA approves on an expedited basis. Under the proposal, Medicare would provide national coverage simultaneously with FDA approval, for a period of four years. As a result, it would streamline local coverage decisions (LCDs). The proposal would also allow Medicare to cover eligible breakthrough devices the FDA has approved for use in 2019 or 2020.
For a fact sheet on the proposed rule (CMS-3372-P), please visit here.
The proposed rule (CMS-3372-P) can be downloaded from the Federal Register here.
HHS Updates Cares Act Provider Relief Fund FAQs
HHS has once again updated the CARES Act Provider Relief Fund Frequently Asked Questions (FAQs).
Of particular note are the questions and answers below, which include information regarding eligibility for Phase II of the General Distribution. As we previously reported, the application deadline is September 13.
Who is eligible for Phase 2 – General Distribution? (Modified 9/1/2020)
To be eligible to apply, the applicant must meet all of the following requirements:
- Must have either (i) directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-related services during the period of January 1, 2018, to December 31, 2019, or (ii) own (on the application date) an included subsidiary that has either directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-related services during the period of January 1, 2018, to December 31, 2019; or
- Must be a dental service provider who has either (i) directly billed health insurance companies for oral health care-related services, or (ii) owns (on the application date) an included subsidiary that has directly billed health insurance companies for oral health care-related services; or
- Must be a licensed dental service provider who does not accept insurance and has either (i) directly billed patients for oral health care-related services, or (ii) who owns (on the application date) an included subsidiary that does not accept insurance and has directly billed patients for oral health care-related services;
- Must have billed Medicare fee-for-service during the period of January 1, 2019 and December 31, 2019; or
- Must be a Medicare Part A provider that experienced a change in ownership and billed Medicare fee-for-service in 2019 and 2020 that prevented the otherwise eligible provider from receiving a Phase 1 - General Distribution payment; or
- Must be a state-licensed/certified assisted living facility.
2. Must have either (i) filed a federal income tax return for fiscal years 2017, 2018 or 2019 or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return. (e.g. a state-owned hospital or health care clinic); and
3. Must have provided patient care after January 31, 2020; and
4. Must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
5. If the applicant is an individual, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee.
Providers who have received a payment under Phase 1 of the General Distribution are no longer prohibited from submitting an application under Phase 2 of the General Distribution. Providers who received a previous Phase 1 – General Distribution payment are eligible to apply and, if they have not yet received a payment that is approximately 2% of annual revenue from patient care, may receive additional funds.
What was the methodology/formula used to calculate provider payment? (Modified 9/1/2020)
The Phase 2 – General Distribution methodology will be based upon 2% of (revenues * percent of revenues from patient care) from the applicant’s most recent federal income tax return for 2017, 2018 or 2019 and with accompanying submitted tax documentation. Payments will be made to applicant providers who are on the filing TIN curated list submitted by state/territory Medicaid or CHIP agencies, HHS-developed lists of dental providers and assisted living facilities, the list of providers who received a Phase 1 – General Distribution payment, or the list of approved CMS-approved Medicare Part A providers who experienced a change in ownership as of August 10, 2020 or whose applications underwent additional validation by HHS.
How can a health care provider find out if they are on the curated list? (Modified 9/1/2020)
When a health care provider applies, the first step of the application process is to validate that their TIN is on curated lists of providers known to be in good standing and eligible under this phase. Applicants that are not on that list will be validated through an additional process with the state or other third-party sources to determine if the provider is a known provider that was not captured initially. HRSA will be working directly with states and third-party sources to authenticate providers not on the curated list and will not be reaching out to individual providers for validation. Please note that it may take additional time to validate an applicant’s TIN. If they receive the results of that validation after August 28, they will still be able to complete and submit their application.
What if an applicant’s TIN is flagged as invalid because it is not on the filing TIN list submitted by states to CMS or the curated list of dental providers? (Modified 9/1/2020)
Payments will be made to applicant providers who are in the filing TIN curated list from CMS if they are a Medicaid or CHIP provider. If a TIN is not on the curated list of state-submitted eligible Medicaid/CHIP providers or T-MSIS, it will be flagged as invalid. In these cases, HHS will work with the states to verify whether the TIN should be included as a valid Medicaid or CHIP provider in good standing.
If a TIN is not on the curated list of dental providers, HHS will conduct additional analysis related to the TIN and any active dental providers associated with the TIN.
If a TIN is not on a curated list of assisted living facilities, HHS will conduct additional analysis related to the TIN and any currently operating assisted living facilities associated with the TIN.
If the TIN is subsequently marked as valid, the provider will be notified to proceed submitting data into DocuSign even if validation occurs after the September 13, 2020 deadline. TINs that cannot be validated will not receive funding. Please note, the additional TIN validation may result in a delay in processing the application.
How should assisted living facilities calculate revenue from patient care? (Added 9/1/2020)
“Patient care” means health care, services and supports, as provided in a medical setting, at home, or in the community to individuals who may currently have or be at risk for COVID-19, whereby HHS broadly views every patient as a possible case of COVID-19. Assisted living facilities that are applying for Phase 2 – General Distribution funds may include patient care revenue that supports residents’ nutritional, housing, activities of daily living, and medical needs, including purchased services.
The application instructions indicate that “real estate revenues” should be excluded from revenues from patient care. For residents that live in skilled nursing or assisted living facilities, are resident fees that cover their accommodations considered service revenue or real estate revenues? (Modified 9/1/2020)
Resident fees that cover their accommodations can be considered patient service revenue.
Lawmakers Remained Deadlocked on COVID Relief; Senate Republicans May Introduce a Narrow Bill Next Week
Congressional Democrats attempted to restart negotiations with the White House last week on a new coronavirus stimulus package, but the two sides remain deadlocked on the total size of the next relief bill. House Speaker Nancy Pelosi (D-Calif.) stated that she is willing to compromise on a $2.2 trillion package, leaving Republicans to increase their current offer by at least $1 trillion. Senate Majority Leader Mitch McConnell (R-KY) indicated that the Senate may introduce a narrow, focused plan next week, that would still require a 60-vote threshold. The proposal, which will cost over $500 billion, is expected to include federal unemployment benefits through the end of December, Paycheck Protection Program funding for small businesses, additional dollars for education, and liability protections for companies, schools and health care providers.