2021 Medicare Fee Schedule - 2 things nephrology practices need to do to take advantage the increases.
2021 Medicare Fee Schedule for nephrology practices
Welcome to 2021! I know that many of us feel like 2020 was a blur and we have never worked harder than we did last year.
A lot was happening in the industry as we finished 2020. While most offices were focused on operating their practice in a post- COVID environment, new kidney care programs were launching, ESCO was winding down, and value-based care seemed to be the central topic of conversations.
Well, we have made it to 2021. Now what?
Let's start with understanding the impact of the 2021 Medicare Fee Schedule on nephrology practices. In this blog post, I am focusing on:
Highlight the changes in the 2021 Medicare Fee Schedule for nephrology practices.
Identify the year-end congressional changes that have an impact on nephrology-related CPT coding.
List the 2 actions needed for nephrology practices to capture increased revenue from the 2021 Medicare Fee Schedule.
How to calculate the projected revenue increase for a nephrology practice using the 2021 Medicare Fee Schedule.
2021 Medicare Fee Schedule’s impact on nephrology practices.
When the Medicare final rule was published, we were disappointed at the considerable reduction of the conversion factor from $36.09 to $32.41, a 10.2% reduction for nephrology.
Fortunately, adjusting the RVUs for several E&M codes helped mitigate the conversion factor reduction. The adjustment ended up providing a decent increase (10-15%) in fees for office follow-up visits and dialysis rounding codes. However, these increases were offset by cuts to hospital visits and dialysis codes of about 10%.
Final year-end congressional changes to the 2021 Medicare Fee Schedule bring revenue increase for nephrology practices.
This year, like most years, Congress passed some adjustments to the 2021 Medicare Fee Schedule at the last minute. Fortunately for nephrology practices, they reversed a large portion of the cuts to the conversion factor by giving a one-year across-the-board increase of 3.75% and moving the conversion factor from $32.41 to $34.89.
Congress's revisions changed the codes that had previously received a negative 10% adjustment to a negative adjustment of 2-4% and moved the 99211-99215 office visits and the dialysis rounding codes to a positive adjustment of 20-24%.
The 2021 Medicare Fee Schedule changes' net result will increase revenue depending on the mix and volume of patient visits for your nephrology practice.
Two things nephrology practices need to do to take advantage of the increases to the 2021Medicare Fee Schedule.
Your practice won’t just automatically receive the updated 2021 Medicare Fee Schedule. You need to be proactive. Doing the following two things will help ensure you achieve the revenue increase associated with the 2021 Medicare Fee Schedule for nephrology practices.
1. Update your Charge Master.
Review your Charge Master to ensure you adjust your charges up if needed to capture the increased fee. For example, the 4-visit rounding code goes up by approximately $70, and a level 4 office visit increases roughly $20.
2. Contact your commercial and Medicare Advantage, payers.
Contact your commercial and Medicare Advantage payers to verify they are adopting the 2021 RVU and conversion factors. Many payers are stating they are staying with the 2020 fees. If this is the case, you will need to open negotiations to update your fee schedule with the payer.
How to calculate your nephrology practice’s revenue increase using the 2021 Medicare Fee Schedule.
The Solutions Healthcare team has created the 2021 Medicare Fee Schedule Calculator - Nephrology Edition to assist nephrology practices in forecasting the increased revenue based on the 2021 Medicare Fee Schedule.
The calculator is easy to use and the first step in any type of forecasting or planning. The calculator clearly highlights in yellow the fields that require your practice’s data. The calculator then automatically applies the appropriate RVU, Conversion Factor, Fee, and Medicare Allowable Fee to calculate the year-over-year increase or decrease.
The calculator only projects the year-over-year change in revenue for the CPT codes that have increased or decreased in the 2021 Medicare Fee Schedule.
The only information you need to use the calculator is your practice’s 2020 Medicare volume for the CPT codes that have changed in 2021. The calculator makes this easy by listing only the codes that have changed. The calculator will then return the increased revenue for the codes that have changed (using your 2020 volumes). All numbers are for planning purposes only.
A downloadable worksheet for nephrology practices to project 2021 revenue increase using the 2021 Medicare Fee Schedule.
Solution Healthcare RCM services
Keeping track of healthcare changes continues to be challenging, time-consuming, and nearly impossible for private practices. Over the past 20 years, Solutions Healthcare has worked with over 40 nephrology practices across the United States. As a Nephrology National Expert, our experience, knowledge, and processes help our clients quickly adapt to medicine's changing face.
Solutions Healthcare’s revenue cycle management and practice management services deliver results today and position our clients for growth.
Our goal is to make private practices successful so they stay in private practice.
Final Thoughts
Medicare billing has many parts to understand. there are several resources to find additional information such as the Centers for Medicare and Medicaid Services, the Center for Connected Health Policy, and Medicare.gov to name a few.
Sources:
CMS’s Medicare Physician Fee Schedule webpage
WPS-GHA’s 2021 Medicare Physician Fee Schedules webpage
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