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News & Press: Government Affairs News

CMS Releases Annual Fee Schedules for Physicians and Outpatient Facilities

Monday, July 29, 2019   (0 Comments)
Posted by: Bradley Coffey, MA, O-CHCP, AAOE Government Affair
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Baltimore, MD - CMS has released the proposed rules of the annual Physician Fee Schedule and Outpatient Prospective Payment System for the 2020 payment year. Highlights of the proposed rules include:

Physician Fee Schedule

  • CMS proposes a $.05 increase for the CY 2020 payment year. The CY 2020 conversion factor would increase to $36.09.
  • CMS is proposing to add three telehealth codes for the treatment of opioid use disorder.
  • CMS proposes to align Evaluation and Management coding with CPT Editorial Panel recommendations to maintain five coding levels for established patients and four levels for new patients.

Outpatient Prospective Payment System

  • CMS is proposing to require hospitals to post their standard charges for all items and services offered in a machine-readable format on the hospital's website;
    • CMS is also requiring hospitals to post insurer negotiated prices for a limited set of "shoppable" services on the hospital website.
      • Hospitals must post these charges for 300 items and services, 70 CMS defined items and services and 230 hospital defined items and services.
  • In a victory for AAOE, CMS is proposing to remove total hip arthroplasties from the Inpatient-Only List.
    • CMS is also proposing to limit RAC review of THA's for one year after removal from the Inpatient-Only List.
  • In another victory for AAOE, CMS is proposing to add total knee arthroplasties to the Ambulatory Surgery Center Covered Procedures List. Addition to this list would allow for performance of TKAs in an ambulatory surgery center.
  • CMS proposes to increase OPPS payment rates by 2.7% based on a market-basket increase of 3.2% minus a .5% adjustment for multi-factor productivity.
  • Under the proposal, ASC reimbursements would increase by 2.7% due to CMS' decision last year to use the hospital market-basket to set ASC reimbursement rates. CMS did not propose any changes to this policy for CY 2020-2023.

Stay tuned for a more thorough analysis of CMS' annual rulemaking and join us on September 9th and 10th for AAOE's Compliance Symposium and Capitol Hill Day!

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