CMS pitches 3 sweeping payment rules for 2020: 10 things to know

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CMS released three proposed rules on July 29, which include payment updates for outpatient and physician services and expanded price transparency initiatives.

Here are 10 takeaways from the proposed rules:

Medicare Outpatient Prospective Payment System

1. Payment update. CMS proposed increasing the OPPS payment rates by 2.7 percent in 2020 compared to 2019. The agency estimates total payments to OPPS providers will be roughly $6 billion higher in 2020 than this year.

2. Price transparency. The proposed rule builds on previous price transparency guidance from CMS by defining "standard charges" to include the hospital's gross charges and payer-specific negotiated rates for an item or service. Hospitals would be required to publish all standard charges online in a machine-readable file. In addition, the rule would require hospitals to publish payer-specific negotiated rates for 300 services consumers are likely to shop for, including 70 defined by CMS, in a searchable and consumer-friendly manner. Hospitals that fail to publish the prices could be fined up to $300 a day.

3. Site-neutral payments. The proposed rule would finish phasing in a policy adopted last year 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 would be paid at a rate of 40 percent of the OPPS rate in 2020.

4. Inpatient only list. The proposed rule would remove total hip arthroplasty from the inpatient only list, making it eligible to be paid by Medicare in both the inpatient and outpatient setting.

Access the 2020 Medicare Outpatient Prospective Payment System proposed rule here.

Medicare Physician Fee Schedule

5. Payment update. CMS proposed increasing physician payment rates by 0.14 percent in 2020. After applying the budget-neutrality adjustment required by law, CMS estimated the 2020 Physician Fee Schedule conversion factor is $36.09, up from $36.04 in 2019.

6. Evaluation and management coding and payment. Under the proposed rule, separate payment rates would be set for all five levels of coding for evaluation and management visits.

7. Medical record documentation. The proposed rule would allow physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse-midwives to review and verify information in a patient's medical record that is entered by other clinicians, rather than re-entering the information.

8. Telehealth services. CMS proposed adding 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.

Access the 2020 Medicare Physician Fee Schedule proposed rule here.

End Stage Renal Disease Prospective Payment System

9. Payment update. CMS expects to pay roughly $11.1 billion to approximately 7,000 end-stage renal disease facilities for providing dialysis services in 2020. That's about $210 million higher than total expected payments in 2019.

10. New and innovative equipment and supplies. Under the proposed rule, CMS would provide a transitional add-on payment adjustment for new and innovative equipment and supplies. To qualify, equipment and supplies must be granted marketing authorization by the FDA on or after Jan. 1, 2020, meet substantial clinical improvement criteria and have a healthcare common procedure code system application submitted.

Access the 2020 End Stage Renal Disease Prospective Payment System proposed rule here.

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