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Providers Get Some Relief in the Consolidated Appropriations Act of 2021

Providers Get Some Relief in the Consolidated Appropriations Act of 2021

12/23/2020  |  Lois Stewart-Wiebe

Providers Get Some Relief in the Consolidated Appropriations Act of 2021

Late last night, 12/21/2020, Congress passed the Consolidated Appropriations Act of 2021, which covers a host of government spending provisions.  Included in the bill is some welcome relief for the otherwise draconian cuts included in the CMS 2021 Fee Schedule Final Rule.  

While there is more analysis required to come up with a hard figure, in general it appears cuts in payments will be reduced significantly in comparison to those in the Final Rule. This was accomplished by several measures including:

  • The addition of $3 Billion into the PFS which will increase payment overall
  • Delayed payment for 3 years for the new add-on code, G2211, which intended to cover complex evaluation and management. 

Other measures that impact payments to the Physician community are: 

  • Extension of the COVID-19 CARES Act moratorium on sequestration until 3/31/2021
  • Maintains current thresholds for qualifying participants to achieve the Alternative Payment Model 5% bonus payment.
  • An extension of the work geographic index floor through 12/31/2021
  • Extension and enhancement of the Paycheck Protection Program to allow recipients to:
    • Deduct forgiven PPP loans
    • Allows some borrowers to receive a second PPP loan
    • Expands PPP loan eligibility to some 501c organizations
    • Increases some kinds of eligible expenses as forgivable


    Surprise Billing:
    As expected, Surprise billing measures for out-of-network emergency services billing are also included in the bill. The rates are based on the median in-network payment rates for services. Notably, should the provider choose to opt for arbitration, the parties are banned from considering Medicare and Medicaid rates. 

    This is a huge bill in scope, and will need further analysis to come up with real figures regarding the final impact to payment reduction. 

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