CMS confirms new, increased 2021 conversion factor following year-end legislation

Following legislation signed into law in December, Congress added $3 billion to the Medicare Physician Fee Schedule (PFS) and delayed implementation of HCPCS add-on code G2211 for three years. As a result, the Centers for Medicare & Medicaid Services (CMS) has confirmed that the new 2021 PFS conversion factor will be $34.8931 instead of $32.4085, as previously finalized in the PFS final rule. CMS also updated the 2021 RVU file. We expect to see a formal announcement regarding these developments in the near future. CMS is also expected to communicate the new conversion factor and payment rates to local Medicare Administrative Contractors (MACs), who will update their schedules accordingly. For accurate rates based on your geographic area, we recommend checking with your local MAC.

MGMA submits comments on CMS prior authorization proposed rule

MGMA offered comments on the CMS proposed rule requiring a limited number of federal payers to support application programming interface (API) standards. CMS proposed that covered payers provide patients access to their claims information via APIs and support API standards for prior authorization transactions with physician practices. The rule would also require payers to support automated approaches to coverage determinations and transmit to practice EHRs the clinical documentation template for the authorization. CMS also proposed that payers would be given 72 hours to respond to an urgent prior authorization and seven days for all others. MGMA strongly urged CMS to include Medicare Advantage and other payers in the regulation and significantly shorten the time payers would have to respond to practices.

2020 MIPS data submission portal open; report by March 31

CMS opened the data submission portal for MIPS clinicians and groups who participated in the 2020 performance year. Data can be submitted until March 31, and you must sign into the Quality Payment Program (QPP) website to report.

CMS has a variety of resources dedicated to assisting participants with their 2020 data submission in its QPP resource library. In addition, MGMA recommends that groups that expect to participate in MIPS for 2021 review recently added guidance that pertains to the 2021 performance period, such as quality measure benchmark files, cost measure information, promoting interoperability measure specifications, and more.

MGMA to ONC: Delay enforcement of information blocking until after PHE

In a comment letter to the Office of the National Coordinator for Health Information Technology (ONC), MGMA called on the agency to tie the start of enforcement of the information blocking requirements to the end of the COVID-19 Public Health Emergency (PHE). The association argued that physician practices are focused on meeting the challenges related to the COVID-19 pandemic and need additional time to prepare for the complex new regulatory requirements. MGMA also called on ONC to develop additional guidance to help practices comply with the law.