Medicare 10% Reduction in Reimbursement for Anesthesia has been reduced to 3%, effective 01/01/2021

The approximate 10 percent reduction in the anesthesia conversion factor (CF) scheduled to take effect on Jan 1, 2021 has been modified.  A statement published by the American Society of Anesthesiologists (ASA) provided the following take on the CAA:

The scheduled cut to the anesthesia conversion factor will be reduced to a 3% cut rather than the previously proposed 10% cut. An improvement, but still entirely inadequate for a specialty already hampered with a flawed payment rate, whose members are caring for COVID-19 patients on the frontlines of the pandemic.

According to an update released by the Centers for Medicare and Medicaid Services (CMS), the new national anesthesia CF will officially be 21.5600 for 2021 instead of the originally set anesthesia CF of 20.0547.  This translates to a 2.9 percent reduction from the 2020 anesthesia CF, which is far better than the 9.7 percent reduction that was authorized in the 2021 Medicare Physician Fee Schedule (PFS) Final Rule.  Your exact anesthesia CF will vary depending on your geographic location.  You can search for the CF in your area by going to the following CMS link: Anesthesiologists Center | CMS

National Surprise Medical Billing proposal is an improvement.

CHICAGO – The American Society of Anesthesiologists (ASA) is pleased that a number of ASA’s priorities were addressed in the most recent COVID-19 stimulus bill; some improvements to the final surprise medical bill provisions and partial relief from the previous draconian Medicare cuts scheduled for January 1, 2021.

“I believe our specialty will be better off in 2021 than was initially anticipated,” said ASA President Beverly K. Philip, M.D., FACA, FASA. “However, the surprise medical bill provisions and the Medicare payment cut relief remain far less than ideal. ASA remains committed to working vigorously on these issues, to ensure that frontline anesthesiologists are in no way disadvantaged.” 

Regarding Surprise Medical Bills, ASA worked with other physician stakeholders to secure important additional improvements into the bill that were not included in the December 11, “No Surprises Act” draft proposal, including:

  • An explicit prohibition on health insurance companies presenting artificially low Medicare, Medicaid and public payer rates to an arbiter as part of the independent dispute resolution (IDR) system.
  • Elimination of unreasonable timelines and other requirements related to patient notification and billing requirements.
  • Enhanced physician access to the IDR process by adding clarity to the “90 days cooling-off period” 

The language in this bill are improvements to earlier proposals, which included aggressive government rate-setting, administrative burdens on small and medium sized practices,  and inaccessible and insurer-friendly dispute resolution processes.