Lawmakers seek to offset MPFS cuts with $3B injection

By Kate Madden Yee, AuntMinnie.com staff writer

December 21, 2020 -- A U.S. Congressional committee has proposed a $3 billion infusion into Medicare that would ease pay cuts demanded by the 2021 Medicare Physician Fee Schedule (MPFS). Radiology advocates and their allies have been lobbying for Congressional action to stave off the cuts.

Rep. Kevin Brady (R-TX) of the House of Representatives Ways and Means Committee has submitted a provision to be included in the 2020 year-end tax and legislation bill that will likely come to vote December 21.

The $3 billion cash boost would result in "payment increases across the board" for Medicare providers, according to the committee -- including radiologists.

"To respond to the concerns of specialists and other providers practicing in the Medicare program about the effects on them of the calendar year 2021 physician fee schedule's budget neutrality rules, the package includes a suite of mitigation provisions that benefit both them and all providers in the Medicare program," the committee wrote.

The provision also proposes the following:

  • A three-year delay of a new code created by the rule, "which will mitigate these cuts by a projected third."
  • A continuation of the current Alternative Payment Model (APM) thresholds for two additional years, "allowing more providers to qualify for the 5% APM payment who would otherwise have been disqualified because of statutory increases in threshold amounts."
  • A three-month delay of the 2% sequester cuts that were to resume on January 1.

"Together, these policies will greatly benefit all providers during the pandemic and mitigate at least two-thirds of the cuts to certain providers due to Medicare budget neutrality requirements," the committee wrote.

The Centers for Medicare and Medicaid Services (CMS) finalized the 2021 MPFS on December 1; the rule mandates significant decreases in radiology reimbursements, from diagnostic and interventional to nuclear medicine and radiation oncology. This month, healthcare providers have been urging congressional leaders to include a proposal that would protect them from these cuts in this year-end legislation.


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