Tag: CMS (Medicare and Medicaid)

To follow up with more information from the recent legislation which added $3 billion to the Physician Fee Schedule and delayed implementation of G2211 (add-on complexity code), CMS has confirmed that the new 2021 conversion factor will be $34.8931 instead of $32.4085. CMS also updated the 2021 RVU file.

We expect to see a formal announcement regarding these developments in the near future.

We also expect CMS 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.

CMS released further information about the Medicare Accelerated and Advance Payment (AAP) program following the Continuing Resolution passage that revised the program’s repayment terms. Most notably, it appears CMS is automatically delaying recoupment for one year and will issue guidance on the recoupment process at a later date. The legislative text stated that CMS could delay payments “upon request” of the provider, and with this announcement, CMS will instead go further by automatically applying the delay to all recipients. From the announcement linked above:

Providers were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.

Drew Voytal
Associate Director
MGMA Government Affairs
Washington, DC