CMS finalizes 2020 payment rules

CMS has finalized payment rules for 2020, including the Medicare Physician Fee Schedule and the Medicare Hospital Outpatient Prospective Payment System and Ambulatory surgical Center Payment System. The agency originally proposed 2020 payment rule changes in July.

The PFS final rule aims to reduce paperwork burdens for clinicians, according to CMS Administrator Seema Verma. The agency proposed a number of rules that would change coding requirements in an effort to simplify.

One area of contention was a change in the coding requirements for evaluation and management (E/M) services that reflect complexity in patient cases. The proposed changes were met with some backlash from industry groups that argued physicians would see a payment drop by collapsing the levels into just a few categories. CMS decided not to go ahead with this change in the final rule, keeping separate payment rates for each of the office and outpatient E/M visit codes, according to AMGA.

“A team-based approach to care requires an infrastructure to support it,” Jerry Penso, MD, MBA, AMGA president and CEO, said in a statement supporting the final PFS. “It also requires the right policies and a payment system that will maintain that infrastructure. This change goes a long way to helping our members deliver the best possible care.”

However, the association wasn’t all pleased with the final rules. It also expressed disappointment with changes in the Merit-based Incentive Payment System (MIPS), with CMS expecting a Part B payment adjustment of 1.4% for participants in the program finalized. Compared to the 9% payment adjustment allowed by Congress for the 2020 payment year, AMGA doesn’t see the program as a viable way to achieve value-based care for more providers switching from fee for service.

CMS also aimed to give physician assistants greater flexibility under the final rule, increased payment for transitional care management services and added a code specifically for the care management of patients with single, high-risk conditions such as diabetes.

It also expanded access to treatment for opioid use disorder in the face of a national overdose and abuse crisis. Opioid treatment programs will be able to be paid by Medicare for treatment services of beneficiaries beginning in 2020.

Within the hospital OPPS final rule, CMS did not include a proposal to force hospitals to display what they charge for healthcare services. The agency said it may include the requirement in its own rule in the future. The rule is currently under review at the Office of Management and Budget.