Congress to ban surprise bills, include provider grant fix in year-end deal
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Lawmakers are poised to soon pass a massive end-of-year legislative package including many healthcare industry priorities including a ban on surprise medical bills, money for vaccine distribution and COVID-19 testing and more funding and flexibility for provider grants, among other provisions.
Congressional leaders announced they have a deal on COVID-19 relief after months of gridlock and released the nearly 5,600-page bill on Monday. Both chambers are expected to vote on the full package as soon as Monday.
Surprise billing
The agreement breaks paralysis that has gripped Washington for years on the issue of banning balance billing, or when consumers receive large bills for out-of-network care provided in emergency situations or at an in-network facility. A broad bipartisan coalition of lawmakers that had squabbled over details involving how insurers and provi
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WASHINGTON, Dec. 10, 2020 /PRNewswire/ Senators John Boozman (R-Arkansas), Kevin Cramer (R-North Dakota), Cindy Hyde-Smith (R-Mississippi), Tom Cotton (R-Arkansas), and Susan Collins (R-Maine) introduced legislation today that will reverse the devastating payment cuts that will further harm the health care system already under strain due to COVID-19.
This legislation will ensure no healthcare professionals receive lower Medicare payments than 2020 levels for the next two calendar years. Stopping these cuts will protect patients by preserving access to quality surgical care and ensuring no physician will face payment cuts amid a historic pandemic. Our nation s physicians are under incredible strain due to COVID-19, and this bill begins to correct a misguided and ill-timed policy that would cut health care spending in the middle of a pandemic, said David B. Hoyt, MD, FACS, American College of Surgeons Executive Director. Time is running out to reverse these cuts and pr
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On December 2, 2020, CMS issued a final rule updating the payment policies and rates for services to be furnished under the Medicare Physician Fee Schedule (PFS) in calendar year (CY) 2021. The final rule includes significant rate increases for evaluation and management services (and a corresponding budget-neutrality adjustment for all other services), an expansion of the telehealth services covered by Medicare, an expansion to the range of covered services for non-physician practitioners, and revisions to the definition of “direct supervision” to include virtual presence for the remainder of the public health emergency.
Highlights
The Centers for Medicare & Medicaid Services (CMS) has published the Calendar Year (CY) 2021 Final Rule for the Medicare Physician Fee Schedule (MPFS), which contains updates to the Quality Payment Program (QPP). The MPFS dictates Medicare rates and policies under Part B, while the QPP implements two value-based payment programs: the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
Among notable changes, CMS has proposed to make permanent certain telehealth changes that have been implemented in response to the COVID-19 public health emergency (PHE), confirmed the evaluation and management (E/M) documentation guidelines and payment changes finalized in the 2020 MPFS, and delayed the MIPS Value Pathway (MVP) until the 2022 performance period or later.