Medicare Proposes Changes for 2020 Calendar Year

The Centers for
Medicare and Medicaid Services (CMS)
are proposing new rule changes to the Medicare
physician fee schedule for 2020. These changes include updates to payment
policies, payment rates, and quality provisions (with some telehealth
provisions included as well). The agency rolled out the new proposal for the
physician fee schedule (PFS) just this past June. As CMS noted in a press
release, the “2020 PFS proposed rule is one of several proposed rules that
reflect a broader Administration-wide strategy to create a health care system
that results in better accessibility, quality, affordability, empowerment, and

Before getting into the specific changes proposed, here’s a
quick recap of how the fee schedule works generally. Physicians and other providers
receive compensation for services under the PFS, with payments determined on
the basis of the resources used to provide the service. As the CMS release
explains, “Relative Value Units (RVUs) are applied to each service for
physician work, practice expense, and malpractice.” Those RVUs are then
converted to a payment based on a conversion factor. Under the new proposed CMS
changes, RVUs are going to be updated, and the conversion factor is going to
slightly increase. What’s more, several telehealth codes for the treatment and
care of opioid use disorders are going to be added to the fee schedule. Evaluation
and Management (E/M) services are also going to be updated; as the press
release notes, “the CPT coding changes retain 5 levels of coding for
established patients, reduce the number of levels to 4 for office/outpatient
E/M visits for new patients, and revise the code definitions.” Physician
supervision will still be required for physician assistants, but the
requirement will be modified to give physician assistants more freedom. Finally,
clinical providers have frequently complained that the existing documentation
policy is redundant and creates a greater burden; these new changes, however, will
take into account that feedback, and alter the process to reduce the redundancy
and burden.

These are just a few of the many changes Medicare is proposing to their physician payment system. Some others include care management updates, bundled payment opportunities, coverage for opioid abuse treatment services, therapy services, ambulance transport services, and a new savings program. These new updates hope to streamline processes, provide greater opportunity, and create a better Medicare system. CMS will be accepting public comments on the proposed changes until September 27.

Click here to read the CMS press release on the proposed fee schedule changes.


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