PRS ALERT: Congress passed a Covid Relief package that included a few impactful changes. G2211 Cannot be Paid until 2024, do not report.

• G2211 will not be paid until January 1, 2024. This provision was added to the stimulus package by Congress. CMS will have to comply. We have not yet seen the specific directives from CMS as the bill is not law. Once it becomes law, CMS will have a very short time to react. We are going to assume at this time; the code will become either bundled or non-covered. They could also rework the values to 0.00 and request or require reporting for tracking purposes.

The Initially projected cost to Medicare for G2211 was $3 Billion, approximately 3% of the Medicare budget for Part B. The change will require CMS to rework its budget neutrality projection and probably increase the conversion factor. At this point, we will project that it will not be necessary to report the G2211.

From a procedural standpoint, the MACs will have change processing programs to accommodate these last-minute changes, so plan for delays in payment for 2021 claims for a couple of weeks. The other changes affecting E/M codes, including the increase in value for E/M codes and the new guidelines, have not been affected by the law, so keep working on implementing those changes to be ready for January 1, 2020.

Other provisions of interest include:

• A payment raise of 3.75% across all specialties after budget neutrality adjustments with funds taken from the US Treasury General Fund.

This along with the budget neutrality impact of blocking payment for code G2211 could mean that the conversion factor for 2021 will be decreased by approximately 3.5% instead of 10.2%.

• Sequestration will be suspended until March 31, 2021, resulting in a 2% raise for the first quarter.

• A second round of the PPP program might be available to smaller practices that have proven impact from Covid and additional clarifications concerning first-round PPP money, taxes and expenses

• A new round of Provider Relief Funding will make money available to practices that prove that income and operations were affected by Covid.

We encourage all of you to read more about this legislation.

We will provide updates as they become available concerning both the Legislation and the CMS response to the legislation.

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Mark N. Painter is a managing Partner of PRS Consulting, LLC, the CEO of PRS, LLC and the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS). Since co-founding PRS in 1989, Mr. Painter has served as the primary coding resource for the PRS products including Hotlines, Coding Manuals and quick reference tools, the Internet based application codingtoday.com and seminars. He has lectured to a variety of groups concerned with health care reimbursement. Mr. Painter's extensive knowledge of physician reimbursement issues has allowed him to assist insurance companies, physicians and their staff members, legal counsel, actuaries, Specialty Societies and consultants on a daily basis. He has serves has an expert to legal counsel, bio device companies and pharmaceuticals. He was a co-chair of the Colorado Clean Claims Task Force, a committee of nationally known industry experts charged with the development of single payment edit database for the state. Mr. Painter is a CPMA. Mr. Painter received his B.A. from Grinnell College at Grinnell, Iowa.