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- CMS’ Final Outpatient, Physician Payment Rules for 2020: 9 Things to Know
CMS’ Final Outpatient, Physician Payment Rules for 2020: 9 Things to Know
December 9, 20191. Payment update. CMS is increasing OPPS rates by 2.6 percent in 2020 compared to 2019.
2. Site-neutral payments. CMS will finish phasing in a policy adopted in 2018 to make payments for clinic visits site-neutral by reducing the payment rate for hospital outpatient clinic visits provided at off-campus provider-based departments. These off-campus departments will be paid at a rate of 40 percent of the OPPS rate in 2020.
3. 340B program. CMS will continue its policy of paying hospitals 22.5 percent less than the average sales price for certain drugs purchased through the 340B program.
4. Prior authorization. Beginning July 1, 2020, CMS will implement a prior authorization process for the following categories of hospital outpatient department services: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty and vein ablation.
5. Price transparency. CMS said it will issue a separate final rule regarding a proposal that hospitals disclose payer-specific negotiated rates.
Medicare Physician Fee Schedule
6. Payment update. After applying the budget-neutrality adjustment required by law, the 2020 Physician Fee Schedule conversion factor is $36.09, up from $36.04 in 2019.
7. Evaluation and management coding and payment. The final rule sets separate payment rates for all five levels of coding for evaluation and management visits.
8. Medical record documentation. The final rule allows physicians, physician assistants, and advanced practice registered nurses to review and verify information in a patient’s medical record that is entered by other clinicians, rather than re-entering the information.
9. Telehealth services. CMS will add a set of codes, which describe a bundled episode of care for treatment of opioid use disorders, to the list of telehealth services covered by Medicare.