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It Really is a New Year!

January 06, 2021

It Really is a New Year!
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Welcome to a new year. So far in 2021, we have new CPT codes, new COVID-19 information, new ICD-10 codes and much more! There is a lot of information to share, so we’ve compiled a few highlights and resources to help you get started this year.

  • Office and Outpatient E/M Code Changes
    The code selection and documentation requirements have changed for codes 99202-99205. Code selection is now based on time or medical decision making for these specific E/M codes.
  • COVID-19 Relief
    On December 23, 2020, Congress passed and the President signed the Consolidated Appropriations Act, 2021. It included some changes directly impacting physician practices, changing the Medicare reimbursement schedule for 2021 and the modifying the 2021 E/M coding guidelines approved in the Medicare Physician Fee Schedule Final Rule published on December 1, 2020.
    • The 2% Medicare sequestration suspension will continue until March 31, 2021.
    • G2211 (the new add on code from the Final Rule) will not be a payable code until January 1, 2024.
    • Medicare payments for 2021 will be increased by $3 billion. Details and the final published fee schedule are still forthcoming, but budget neutrality was suspended.
  • Quality Payment Program
    • The QPP reporting portal is open for 2020!  Quality and Promoting Interoperability (PI) data and Improvement Activities attestations should be submitted before the portal closes on March 31.  Failure to report (if required) may result in a 9% penalty on all Medicare payments in 2022. (NOTE: MIPS-APM participants should report PI data through this portal).
    • The Quality Payment Program (QPP) Participation Status Tool has been updated with the  final 2020 eligibility status and your initial 2021 eligibility for the Merit-based Incentive Payment System (MIPS).
    • Payment adjustments for 2021 dates of service are based on the 2019 MIPS score. For information on how the payment adjustment is calculated, click here.
    • COVID-19 and 2020 Participation: The Extreme and Uncontrollable Circumstances Exception Application deadline (originally set for December 31, 2020) has been extended to February 1, 2021.
      CMS will be using the Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency.
      (Note: If you have any concerns about the effect of the COVID-19 pandemic on your performance data, including cost measures, for the 2020 performance period, submit an application now and be sure to cite COVID-19 as the reason for your application.)
    • APM Performance Pathway (APP)
      Beginning in 2021, the APM Performance Pathway (APP) is a new reporting framework, complementary to the MIPS Value Pathways (MVP). The APP is available only to participants in MIPS APMs and can be reported by the individual eligible clinician, group or APM Entity.
  • New ICD-10 Codes for COVID-19 Related Conditions
    As a result of the ongoing COVID-19 public health emergency, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) is implementing additional codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for reporting to include:
    • Encounter for screening for COVID-19 (Z11.52)
    • Contact with and (suspected) exposure to COVID-19 (Z20.822)
    • Personal history of COVID-19 (Z86.16)
    • Multisystem inflammatory syndrome (MIS) (M35.81)
    • Other specified systemic involvement of connective tissue (M35.89)
    • Pneumonia due to coronavirus disease 2019 (J12.82)
  • New Advanced Beneficiary Notice Form 
    Due to COVID-19 concerns, CMS has expanded the deadline for use of the renewed ABN, Form CMS-R-131. At this time, the renewed ABN is mandatory for use on January 1, 2021. The renewed form may be implemented prior to the mandatory deadline.
  • LA Medicaid Updated COVID Informational Bulletin is updated regularly and includes the latest vaccination information for Louisiana Medicaid physicians.

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