Medicare Physician Fee Schedule for calendar year 2021 released: the impact on nursing homes and assisted living providers

Authored by Jennifer Schwalm and Sophie Campbell

 The Medicare Physician Fee Schedule for calendar year 2021 has been finalized by the Centers for Medicare & Medicaid Services (CMS) with significant reductions in reimbursement for multiple services that are paid by Medicare Part B. Medicare Part B services are delivered to residents in both long term care and the personal care and assisted living settings. A 9% decrease to Medicare Part B therapy reimbursement has been approved by CMS, while providers are being struck hard by the costs of the COVID-19 pandemic with testing, quarantine and decreased occupancy. A certain level of therapy can maintain the strength of residents to prevent hospitalizations, falls and possibly even COVID-19.

Additionally, the Medicare Physician Fee Schedule for calendar year 2021 includes a reduction in payment for physician services to patients in the skilled nursing setting, and such cuts — especially as services are affected by COVID-19 restrictions — make it challenging to sustain a practice with such a focus. The adjustment will not affect the physician office visits and will only affect the physician and physician extender visits in the skilled nursing facility. This could increase the difficulty in securing physician and physician extender services in the skilled nursing facilities.

For more information on this topic, or to learn how Baker Tilly’s clinical specialists can help outline alternative strategies to ensure safe and appropriate resident care in light of the decreased Medicare funding, contact us now.