As noted above, the work RVUs for 99283–99285 were increased by more than 5 percent for 2021. Those three codes account for about 90 percent of the ED E/M services reported to Medicare.

Net Impact of RVU Increase and Congressional Actions

10.2% (the conversion factor cut) – 5.0% (a conservative estimate of all the ED code RVU increases combined) = 5.2% prior to the recent Congressional action.

With the relief provided by the Consolidated Appropriations Act of 2021 reducing cuts by 3.75 percent through an influx of congressionally approved funds and eliminating a roughly 3 percent contribution to budget neutrality by delaying the implementation of the office add-on code G2211, overall emergency medicine could potentially swing to a positive for 2021.

All in, emergency medicine went from a potential 10.2 percent cut to a gain, which could be as much as 2 percent, depending on the group.

The temporary removal of the sequestration cuts is a bonus. However, if sequestration is not delayed again and goes back into effect in April 2021, all Medicare physician payments will be reduced by 2 percent for the remainder of the year.

This is a tremendous win based on the advocacy work through the ACEP Relative Value Scale Update Committee Team and the legislative and regulatory efforts of ACEP’s staff.

ED Continued Traction with Telehealth Services

CMS considered which codes temporarily on the list of approved Medicare telehealth services during the COVID-19 public health emergency will remain on the list permanently. Ultimately, CMS agreed to keep ED E/M code levels 1–5 (Current Procedural Terminology [CPT] codes 99281–99285), critical care, and observation codes 99217 and 99224–99226 on the list of approved Medicare services through the duration of the year the public health emergency expires. Unfortunately, CMS did not add any of these codes to the permanent approval list for telehealth, citing these services as too intense to be routinely performed via telehealth.

Teaching Physicians and Residents

For rural settings only, CMS has made oversight via telemedicine permanent for teaching physicians supervising residents in residency training sites outside of an Office of Management and Budget–defined metropolitan statistical area (generally defined as an urban cluster of more than 50,000 people). Moonlighting resident flexibilities, allowing an emergency medicine resident to work elsewhere outside the scope of their residency duties, have been extended to Dec. 31, 2021, or may be made permanent to help cover physician shortages due to the public health emergency.

Medical Documentation Requirements

In last year’s rule, CMS finalized numerous changes to the medical record documentation requirements for physicians and other health care practitioners. In this 2021 Final Rule, CMS is clarifying that physicians and other health care practitioners, including therapists, can review and verify documentation entered into the medical record by members of the medical team for their own services that are paid under the Physician Fee Schedule.

Merit-based Incentive Payment System (MIPS)

For 2020 and 2021, the four typical reporting categories—quality, cost, improvement activities, and promoting interoperability—continue (see Table 3).

Table 3: 2020 and 2021 MIPS Performance Category Weighting