CMS (The Centers for Medicare and Medicaid Services) decides to upgrade the Medicare payment adjustments for three types of physicians namely:
- Skilled nursing facilities
- Inpatient psychiatric facilities
This step is great in order to reward the healthcare professionals in the respective facilities for their up-scaled services, especially during the pandemic.
How it will impact the Hospices?
Right from the year 2021, hospice payment rates will be raised by the market basket percentage of 2.4%. In numbers, this percentage is around $540 million.
Where CMS has shown support in the payment rate, they also demand quality reporting services. Hospices failed to meet the performance threshold will have to face a 2% decline in the annual payment market basket.
The system also has a statutory aggregate cap that puts a limit to payments made to the hospices.
The final cap amount for FY 2021 is $30,683.93 updated by 2.4% as per 2020.
How it will impact the Skilled Nursing Facilities?
The aggregate payments to skilled nursing facilities are going to increase by 2.2%, in 2021, which is $750 million.
These facilities are upgraded by the routine technical rate-setting updates in payments. The final rule also applies a 5% cap on the wage index, which is lower than in 2020. Hearing the concerns of the stakeholders, CMS also tweaked the ICD 10 code maps, which will be in effect from 2021.
The updated mapping address the care based patient characteristics under Medicare Patient-Driven Payment Model.
However, the payments for skilled nursing facilities depend on the performance of a single claims-based, all-cause, all-condition hospital readmission measure.
How it will impact the Inpatient Psychiatric Facilities?
Inpatient psychiatric facilities will observe an increase in their payment rate by 2.2%, estimated to be $95 million in 2021.
Office of Management and Budget statistical area delineations will be revised to better estimate the cost born by the healthcare professional.
With this update, the following physicians will be able to practice within the scope determined by the state law.
Advanced practice providers including:
- Physician assistants
- Nurse practitioners
- Clinical nurse specialists
They also have to record the progress of their patient along with the medical record.
Further efforts would be required to dissolve the inconsistencies that don’t align with the latest final rules changes and to loosen the regulatory conditions.
We hope CMS brings more innovations to reduce administrative burden and improve payment rates for all physicians.
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