ED Coding & Reimbursement Alert - 2020 Issue 16
Reimbursement: Feds Propose Major Cut to Conversion Factor
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Article Overview
This article summarizes major elements of CMS’s Calendar Year 2021 Medicare Physician Fee Schedule proposed rule. It is aimed at providers, coders, compliance staff, and reimbursement professionals who need a high-level view of upcoming Medicare payment policy changes, including telehealth expansion, office/outpatient E/M updates, and broader physician payment impacts. The discussion focuses on policy direction, timing, and stakeholder reaction to the proposed rule.
Why This Topic Matters
The proposed rule has broad implications for Medicare reimbursement and operational planning across specialties. Understanding the scope of the changes helps organizations assess potential revenue effects, prepare for policy shifts, and monitor rulemaking timelines.
Article Sections
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Check Out 3 Important Details
An overview of the major policy areas highlighted in the proposed rule. The section introduces the article’s main reimbursement topics and the broad areas of Medicare payment change.
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1. Expect a Post-COVID Telehealth Expansion
Discussion of telehealth-related proposals, pandemic-era flexibilities, and related Medicare coverage developments. The section also addresses how the proposed rule fits into broader temporary and permanent service changes.
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2. Get Ready for 2021 E/M Changes
Coverage of office/outpatient evaluation and management policy updates and their timing within the 2021 schedule. The section also notes anticipated effects on reimbursement patterns across specialties.
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3. Prepare for Whopping Conversion Factor Drop
A summary of the proposed physician fee schedule conversion factor change and the budget-neutrality context behind it. The section includes stakeholder response and comment timeline information.
What You Will Learn
- How CMS frames the CY 2021 Medicare Physician Fee Schedule proposed rule
- What categories of telehealth and virtual care policy are addressed
- What broad office/outpatient E/M updates are included in the proposal
- Why the conversion factor change is important to physician reimbursement
- Which organizations and stakeholders are reacting to the proposal
Who Should Read This
- Medical coders
- Compliance professionals
- Revenue cycle staff
- Physician practice administrators
- Healthcare reimbursement analysts
- Medicare providers
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