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Bills Addressing the Physician Fee Schedule Conversion Factor Cut

Advocacy

H.R. 8505

Reps. Michael Burgess (R-TX) and Bobby Rush (D-IL) introduced H.R. 8505 to delay the proposed physician fee schedule budget neutrality adjustments for one year. This proposal would not impact the proposed increases to payment for Evaluation & Management (E/M) services but would postpone the decreases in the conversion factor that would bring down provider reimbursement levels in 2021. The delay would be paid for with $10 billion in unallocated funds from the Provider Relief Fund which was created to address health care provider needs under the pandemic. The bill would not provide a long-term or permanent solution to the provider cuts, but it would provide extra time to seek a consensus path forward.

H.R. 8702

Reps. Ami Bera (D-CA) and Larry Bucshon (R-IN) introduced H.R. 8702, the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020. This bill would offset the cuts to provider reimbursement by providing add-on payments to affected services for two years. The “hold harmless” payments would equal the difference between 2020 and proposed 2021 reimbursement for individual service codes. These payments would exist outside of the Physician Fee Schedule, so they would not be subject to budget neutrality requirements. E/M services 99212-99215 would not be eligible for the add-on payments, and E/M services 99202-99205 and 99211 would be ineligible when billed in conjunction with the proposed complex patient add-on code, GPC1X (these services would see increased reimbursement under the proposed Physician Fee Schedule, which prompted the proposed cuts to other services to maintain budget neutrality). This bill provides a longer-term solution than the Burgess-Rush bill (by one year) but does not permanently solve the issue of the provider reimbursement cuts.