As a result of advocacy by an American College of Radiology (ACR)-led medical coalition, representing more than a million providers, and efforts with other physician partners, the newly-passed Consolidated Appropriations Act, 2021 (Omnibus and Coronavirus Relief Bill) includes: a significant reduction in anticipated Medicare provider payment cuts due to evaluation and management (E/M) coding changes; phased-in implementation of these E/M adjustments; and a vastly improved “surprise medical billing” policy.

ACR support also helped secure a one-year delay of the radiation oncology payment model in the year-end legislation, according to ACR officials. The final policies are marked improvements on previous legislative framework.

“Even in such a divided political atmosphere, worsened by the impact of COVID-19, the ACR worked with members of Congress to significantly improve the Medicare payment, ‘surprise billing’ and radiation oncology provisions in this legislation,” says Howard B. Fleishon, MD, MMM, FACR, chair of the ACR Board of Chancellors. “We will work with the new Congress and administration to build on these policies to ensure that radiologists and other providers can continue to serve their communities in these turbulent times and that Americans continue to have ready access to high-quality radiologic care.”

Medicare Provider Payment Cuts

The bill rolls back the Medicare payment cuts to radiologists, due to E/M changes, by more than half—from 10% to approximately 4% for 2021—with further, phased-in adjustments thereafter. This legislative mitigation offers a reprieve from the disastrous cuts that were slated to start January 1, and an opportunity for the ACR and its coalition partners to continue to address these cuts with the Centers for Medicare & Medicaid Services and the new Congress.

“With the economic impact of COVID-19, immediate double-digit Medicare provider cuts would have devastated patient access, communities and provider practices. The mitigation in this bill is a far better immediate outcome for radiologists and other providers than we would have otherwise faced on January 1. The ACR will continue to work with lawmakers and regulators to promote better payment policies that strengthen healthcare quality, equity, and access,” said Fleishon.

“Surprise Billing”

As recommended by the physician community, including the ACR, the improved legislation ensures that consumers are held harmless from “surprise medical bills” and establishes an equitable process for provider-insurer dispute resolution.

At ACR’s urging, Congress:

  • Removed the monetary threshold to access independent dispute resolution
  • Removed provisions using the median in-network rate as an initial benchmark for payment
  • Inserted language to explicitly exclude Medicare, Medicaid and workers’ compensation payment rates from consideration in the independent dispute resolution process
  • Removed the logistically problematic timely billing provisions

As such, the bill is a significant step forward for patients and providers, Fleishon says. “This legislation provides needed protections for patients and a broad, first step framework to address provider-payer payment disputes,” he adds. “We are glad that Congress acted on the improvements we offered to make this policy better for patients and providers.”