Medicare 2021 Proposed Rules for Physician, ACO, Outpatient and Ambulatory Surgery Payments

On August 3rd, the Centers for Medicare and Medicaid Services (CMS) released an omnibus proposed rule that would update the calendar year (CY) 2021 Physician Fee Schedule (PFS), the CY 2021 Quality Payment Program (QPP) regulating incentive payments for Accountable Care Organization (ACO) and non-ACO participants, as well as policies for the Medicare Diabetes Prevention Program Expanded Model (MDPP). Proposed changes to the PFS are more substantial than in recent years, particularly for specialist services.

On August 4th, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule regarding the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2021. The rule also updates regulations regarding the hospital Star Rating methodology and physician-owned hospitals.

The attached documents (PFS, OPPS and ASC) summarize major provisions of the proposed rules. CMS will accept comments on these proposals until October 5th.