October 2019 ~

Officials at the American College of Radiology (ACR) and other stakeholders are sharing their concern regarding the proposal to increase payment for E/M codes in 2021, suggested in the 2020 Medicare Physician Fee Schedule (MPFS) Proposed Rule.

The ACR is seeking help in its efforts to urge Congress to stop CMS from implementing proposed changes to the Evaluation and Management (E/M) Codes that they say could result in severe cuts to radiology.

According to CMS, the proposed changes are intended to reduce administrative burdens and improving payment rates. The agency says the proposed reimbursement changes would “greatly benefit” some doctors, but penalize others who do not bill for E/M services. CMS has estimated that the proposed E/M increase would produce a significant payment decrease of 8% to the specialty of radiology –a specialty which, the ACR states, very rarely bills for E/M codes, if at all.

The ACR is also sharing research results from a prominent Washington-based healthcare research and consulting firm, the Moran Company (TMC), which estimates a 9% reduction, translating to roughly $452 million a year, trended to $5.6 billion over ten years. The proposed 2020 MPFS reductions would be in addition to the approximate 12% overall payment reductions to diagnostic radiology services from 2006 to 2017.

In a statement issued on October 1, the ACR argued that E/M services account for about 25% of all Medicare dollars, and such changes should be debated by the House. The ACR also wants to suspend budget neutrality as it relates to this change.

“The proposed CMS policy would reallocate tens of billions of those dollars, which goes beyond the appropriate scope of the power of the executive branch and rightly deserves to be debated in Congress,” ACR CEO William Thorwarth, MD, said in a prepared statement. “Only Congress can waive the ‘zero-sum game’ of the Medicare Physician Fee Schedule. ACR will work to get legislation to remedy this proposal considered by Congress.”

 

 

Source(s): RBMA Washington Insider, October 28, 2019; American College of Radiology; Radiology Business;