The Centers for Medicare and Medicaid Services releases Physician Fee Schedules annually, but 2020 is a year that comes with great change. In a few weeks, 2020 will reflect an Administration-wide emphasis on maximizing healthcare accessibility, driving quality, and increasing affordability while encouraging innovation. Additionally, the new fee schedule will enable a wide variety of providers, practitioners, and entities to provide services as a method of team-based care and hopefully help the entire healthcare industry prepare for value-based contracting.
I wanted to highlight a few aspects that drew my attention:
- Documentation: Documentation is getting a bit of an overhaul for primary care services. Evaluation and Management services (E&M) have been scrutinized for years for requiring too much documentation for the reimbursement amount. To decrease documentation burden, CMS has aligned with the AMA CPT) guidelines to achieve the following:
- Deleting the 99201 code for new patients, while keeping the 99211 for established patients.
- Assigned separate payments, rather than blended rates, for 99202-99215 CPT codes, the level of a visit is based on clinical decision making or time, which will provide clinicians with appropriate reimbursement, more time spent with a patient result sin increased payment.
- For extended or prolonged visits, you can add a G code of GPC1X to the 99 codes, to be implemented in 2021.
- Care management services: Existing Transition Care Management (TCM) and Chronic Care Management (CCM) are favored services in delivering value-based care and a new CPT has been introduced, Principal Care Management (PCM) for those with one chronic condition. In order to not disrupt too much, a few G codes have been added to assist with coding.
- TCM- Higher payment rates have been approved for 99495 and 99496.
- CCM- For non-complex CCM, CMS is using 99490 with a new G code of G2058.
- PCM- Because CCM requires patients to have 2 or more chronic conditions, the PCM was created for additional care provided to patients with at least one chronic condition. The codes are G codes: G2064 and G2065.
- Telehealth: CMS did add a new CPT code, 99458, to pay for remote patient monitoring and interpretation of digitally collected data with 99457 and 99458 covering 20-minute intervals of remote services. In 2020, the two CPT codes will be billable under general supervision, which will provide more room for team-based care.
- Opioid management: Specific codes for therapy and treatment have been introduced to further aid in opioid use and disorder treatments.
- CMS is approving of new Medicare Part B medications for medication-assisted treatment furnished by opioid treatment programs.
- CMS is finalizing a zero copay for beneficiaries in 2020 undergoing approved opioid treatment.
- Bundled payment rates are being determined and established as well as approved drug components of the bundles.
- Physician Therapy and Occupational Therapy modifiers have been established for the therapy provided.
- MSSP quality reporting: CMS is aligning the MSSP more closely with MIPS to reduce the burden on resources.
- ACO 43, which is the Ambulatory Sensitive Condition Acute Composite Score, will be pay-for-reporting for performance years 2020 and 2021 because of a substantive change.
- A change to ACO 17 for tobacco screening will be made for 2020 but will remain as-is for 2019.
- There will be a total of 23 measures for ACOs to report during the Group Practice Reporting Option (GPRO).
With these changes coming down the pipeline it becomes so incredibly important to be up-to-date for proper reimbursement both on a fee-for-service basis for services rendered as well as on the quality metric reporting front. The movement to risk will be resource-intensive but should lean towards changes that promote interoperability, decrease burden, and further outcome-based care.