Top 8 Changes Medicare Payment Systems Will See In 2020

Top 8 Changes Medicare Payment Systems Will See In 2020

The Centers for Medicare & Medicaid Services (CMS) is implementing 8 major changes this year to the Medicare payment systems, according to Becker’s ASC Review (2019). A majority of these changes come from the organization’s 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule (CMS, 2019). Other changes were due to the finalization of the CY 2020 Medicare Physician Fee Schedule Final Rule (CMS, 2019). Navigating the changes to the Medicare payment systems can be tricky if coding teams don’t have the proper knowledge. Contact YES HIM Consulting to a customized plan for coding support services and coding education.

Prepare for these Medicare Payment Changes

Here’s a brief description of the changes (follow the links for in-depth information):

  1. CMS UpdatesA site-neutral payment policy, as well as a total knee arthroplasty, was added for Ambulatory Surgery Centers (ASC) (Becker’s ASC Review, 2019). The knee replacement procedure is now applicable for Medicare payment.
  2. CMS removed a total of 6 spinal operations from the inpatient-only list (Becker’s ASC Review, 2019). They are now eligible for Medicare payment in both the hospital outpatient and inpatient settings.
  3. Several angioplasty and stenting procedures will be paid for in the ASC setting since the beginning of 2020 (Becker’s ASC Review, 2019).
  4. The reporting requirements of the Merit-based Incentive Payment System (MIPS) underwent changes to simplify the rules for providers (Becker’s ASC Review, 2019).
  5. Starting in January 2021, all U.S. hospitals must publicly report the standard prices and information. According to the finalized price transparency policy (Becker’s ASC Review, 2019) for Outpatient Prospective Payment System (OPPS).
  6. Due to fee schedule updates, CMS expanded the privileges of certified registered nurse anesthetists (CRNA) in ASCs. To “perform the anesthetic risk and evaluation on the patient they are anesthetizing,” according to Becker’s ASC Review (2019). CMS extended payments to CRNAs.
  7. CMS modified the E/M coding requirements. They match those enforced by the AMA CPT Editorial Panel for Office and Outpatient E/M visits (Becker’s ASC Review, 2019).
  8. the CMS 2020 physician fee schedule will cover treatments and programs for opioid-use disorder (Becker’s ASC Review, 2019).

For Additional Information

Visit www.cms.gov for complete details about each change. For more information about the Medicare Advantage program, view our previous articles “HCC Medicare Advantage Background and Overview” and “HCC Chronic Conditions and M.E.A.T. Criteria.” Navigating the changes to the Medicare payment systems can be tricky if coding teams don’t have the proper knowledge. Contact YES HIM Consulting to a customized plan for coding support services and coding education.

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Medicare Payment Systems

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