Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through December

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the sequestration payment adjustment percentage of 2% applied to all Medicare Fee-for-Service (FFS) claims from May 1 through December 31, 2020.  The Consolidated Appropriations Act, 2021, extended the suspension period to March 31, 2021. An Act to Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes, signed into law on April 14, 2021, extends the suspension period to December 31, 2021. payment adjustment percentage of 2% applied to all Medicare Fee-for-Service (FFS) claims from May 1 through December 31, 2020.  The Consolidated Appropriations Act, 2021, extended the suspension period to March 31, 2021. An Act to Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes, signed into law on April 14, 2021, extends the suspension period to December 31, 2021.

 NO SURPRISE Billing Act (NSA)

Starting with the first day of 2022, the No Surprise Billing Act went into effect. That means that out-of-network (OON) anesthesia providers are prohibited from the age-old practice of balance billing—at least in most cases.  For example, if a patient is seeking a surgical service in a facility that participates with the patient’s insurance plan, and an OON practitioner provides the anesthesia in that surgical session, the OON provider cannot bill the patient the difference between what the insurance pays and the provider’s “full charge,” i.e., group rate.  Rather, a reduced rate that is more in line with an “in-network” charge is what the group can expect to collect from the patient. 

Anesthesia Unnecessary for ESIs effective 12/12/2021

Effective December 12th CMS will be implementing changes to its National Coverage Policy.
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36920
 
Item 4 under Limitations has been brought to our attention:
Use of Moderate or Deep Sedation, General Anesthesia, or Monitored Anesthesia Care (MAC) is usually unnecessary or rarely indicated for these procedures and therefore, is not considered medically reasonable and necessary.16 Even in patients with a needle phobia and anxiety, typically oral anxiolytics suffice. In exceptional and unique cases, documentation must clearly establish the need for such sedation in the specific patient.

2022 Quality Measures for Anesthesia

The 2022 FR provides details on how the Merit-based Incentive Payment System (MIPS), MIPS Value Pathways (MVPs), Alternative Payment Models (APMs) and other features of the Quality Payment Program (QPP) will operate during the 2022 performance year and beyond.

According to the ASA, CMS finalized the anesthesiology MVP for the 2023 reporting year.  In 2022, QPP participants will see some modifications to the program, including:

HHS Announces New COVID Relief Funding and Extension of First PRF Reporting Deadline

The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced $25.5 billion in new funding for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic. The application will open on September 29, 2021.