Regulatory alert: Medicare finalizes 2021 payment and quality reporting changes

12/02/2020 11:06 AM | Rebekah Francis (Administrator)

The Centers for Medicare & Medicaid Services (CMS) released the final 2021 Medicare physician fee schedule (PFS) rule this evening, which includes changes to the Merit-based Incentive Payment System (MIPS) and alternative payment model (APM) participation options and requirements for 2021. The final rule:

  • Sets the CY 2021 PFS conversion factor at $32.41 and the CY 2021 national average anesthesia conversion factor at $20.0547. MGMA is advocating for a legislative fix to address the reimbursement cuts resulting from the lower conversion factor;
  • Generally confirms E/M office visit documentation guidelines and payment changes finalized in the 2020 PFS;
  • Modestly expands telehealth coverage; and
  • Establishes MIPS reporting requirements for 2021 and sets the performance threshold at 60 points.
For more information, review the physician payment fact sheet and QPP zip file associated with the 2021 final PFS. MGMA will analyze the final rule and provide a detailed analysis as a member benefit. MGMA will also provide further education on this complex regulation during our 2021 Medicare Outlook member-benefit webinar on Thursday, Dec. 10 at 1 pm ET.


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