Help Stop 2021 Medicare Cuts – Contact Your Legislators
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Last month, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2021.
The declared intent of this rule is to improve reimbursement of E/M services and expand coverage of Telehealth and other services including Opioid Use Disorder Treatment. To offset the budgetary impact of these increases, which HHS is required
to do, the rule implements significant proposed reductions for other services. Increases and reductions are accomplished by reassigning RVUs for certain services. Unfortunately, payments to chiropractic physicians and other providers will
be significantly reduced.
Medicare uses a system of “relative value units” (RVUs) to arrive at its fee schedule. RVUs are applied to each service for physician work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion
factor. Each CPT code is given a value, expressed as a number of “RVUs,” that is then multiplied by a “conversion factor” to calculate the fee. In short, Medicare is cutting the relative value units (RVUs) for 9894x codes by 10% (7% physician
work and 3% practice expense). Additionally, they are cutting the conversion factor by over 10%. The result is a Medicare allowable amount cut of 19.54% for chiropractic adjustments. Of course, spinal adjustment – CPT codes 9894x – is the only service
for which Medicare pays chiropractic physicians, and these changes are unacceptable.
The Ohio State Chiropractic Association is strongly against these changes. The impact that that these reductions will have on the chiropractic profession and the Medicare patients that we serve are ill-advised, inconsistent with the rule’s purpose,
and will have far reaching effects. Therefore, we are taking action on your behalf and encourage you to do the same.
- The OSCA has filed official comments to HHS and CMS regarding the rule. This is an important step in our formal advocacy efforts to ensure that CMS is fully aware of the negative impact of these changes.
- We are asking all DCs in Ohio to reach out to your Congresspersons, urging them to take action to prevent the rule from becoming finalized. We are providing all Ohio DCs with the information and means to easily contact your Congresspersons, asking them to act on behalf of chiropractic physicians and our patients. Please see the link below to take action and send a letter..
- OSCA is also working with ChiroCongress and many other state associations to increase the strength of our voices, and the impact we can have by working in larger numbers to communicate with CMS and Congressional leaders on this very important issue.
For a more detailed explanation of how the changes were calculated, the CMS proposed rule modifies two key factors that are important to chiropractic physician Medicare reimbursement: relative value unit (RVU) for the codes that are covered by Medicare
and the conversion factor for all RVUs. Medicare uses the total RVU as a multiplier against the conversion factor to determine billable amounts for services. For example, CPT code 98940 (chiropractic manipulative treatment; spinal; 1-2 regions) has
a national RVU of .8 in 2020, and the overall 2020 conversion factor is 36.09. The Medicare allowable amount is calculated by multiplying 36.09 x .8 = $28.87 as the national (not geographically adjusted) billable amount.
However, this proposed rule for 2021 will decrease the RVU for CPT code 98940 from .8 to .72 (a 10% decrease for all 9894x codes). To make matters worse, the rule will also lower the conversion factor from 36.09 to 32.2605 (a greater than 10% decrease).
The overall effect of these two negative adjustments to the only covered codes for chiropractic physicians is a resulting 19.54% reduction in Medicare allowable amounts.
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