CMS Announces New Terms for Repayment of Medicare Advances for Radiologists During This Economic Downturn

The CMS (Centre for Medicare and Medicaid Services) released its final rules and guidelines governing the Medicare system of payment for 2021, thus affirming a radical cut in the reimbursement of radiology in 2021, which was proposed early in 2020. However, some surprises sprung in the MPFS (Medicare Physician Fee Schedule) Final Rule, which was not present in the set of proposed rules, besides minor changes in the conversion factor of the fee schedule and a tweak in the QPP Performance Threshold.

CMS is now offering docs as well as suppliers with one year from the original date of funds issued as for repayment of loans under Accelerated and Advance Payment Program, instead of 120 days. Major groups like the AMA (American Medical Association) have urged the federal agencies to relax the strict terms of repayment, calling imminent due dates as the “economic sword that is hanging over the practice of physicians.” The then POTUS, Donald Trump, responded by signing the legislation and propelling the action of the agency.

In a statement, Seema Verma, the administrator said, “In the adverse scenario of a record pandemic, frontline suppliers and providers needed something, a lifeline, to stay afloat. The advanced payment system of CMS loans was offered to suppliers and providers to avoid closing doors and causing potential service disruption for seniors. Whereas we could see patients returning to hospitals and physicians providing the best care, we are yet to be free from the virus.”

Having said that, the feds doled out USD 106 billion in total payments to ensure smooth issues of cash flow as the volume of imaging-guided procedures, routine cancer checkups, and screenings, and outpatient requirements reduced drastically. Dollars were glowing to over Part A providers counting 22,000, adding USD 98 billion in the form of accelerated payments. Further, Part B suppliers estimating 28,000, which included doctors, suppliers of robust medical equipment and nonphysician practitioners received some advanced payments of over USD 8.5 billion.

Payments started in August 2020, before the action of the legislators. After the first year of issuance, Medicare shall be recouping an estimated 25% from payments to Medicare which was owned to other providers for another 11 months. Thereafter, collection shall double up to 50% for at least 6 months. Finally, if any doctor maintains some balance at the end of 29 months, the CMS shall demand full repayment, subject to a 4% rate of interest.

CMS shall issue letters for repayment of the outstanding balance, subject to the interest charges. This letter shall also provide the guidelines on Extended Repayment Schedule, or ERS, for suppliers and providers experiencing extreme financial hardships. ERS is a plan for debt installment payment, which allows suppliers or providers to pay the debt over three years, or even five years, in the event of hardships. The CMS encourages suppliers and providers to contact the MAC (Medicare Administrative Contractor) for information on EMS and how to go about it. CMS shall communicate with suppliers and providers in the weeks to come as to the terms of repayment and amount of money owed according to advance or accelerated payment.

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