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Congress Passes Omnibus Spending Legislation

From the American Medical Association

Late yesterday, Congress passed a comprehensive omnibus spending package that funds the federal government through FY 2021, provides a new round of COVID relief and economic stimulus, and imposes new restrictions on surprise medical billing. 

As the attached topline summary shows, the surprise billing provisions include several important improvements over a proposal that was circulated last week, which include the following:

  • Clarification that an upfront, initial payment or notice of denial is required from the plan to the physician;
  • An increase in the time for a physician to pursue independent dispute resolution (IDR), from 2 to 4 days;
  • Prohibition against considering public program rates like Medicare, Medicaid, and Tricare during the IDR process; and
  • Elimination of problematic timely billing provisions.

With respect to COVID relief, the legislation would ease the impact of Medicare fee schedule budget neutrality adjustments due to improved evaluation and management (E/M) office visit payment and coding rules, as well as an extension of the 2% Medicare sequester moratorium through March 2021.  A topline summary of these and other significant provisions of the omnibus spending provisions, as well as a table estimating the impact of the Medicare payment changes (excluding the sequester moratorium extension) are attached.

In the closing days of the 116th Congress, Federation groups and our physician members confronted some extraordinary challenges beyond those directly associated with the COVID-19 pandemic.  Thanks to combined strength and close collaboration, medicine faced these challenges head on and this final legislative package shows meaningful results.  We look forward to continuing this good work in the New Year.

Summary Of Surprise Billing Language

Topline Summary Of Select Provisions Of Consolidated 2020 Omnibus Legislation

Cy2021 Combined Impact Without G2211 In Cf With Additional 3.75 Percent Cf Increase


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