Updated on: November 21, 2019

News Alert: CMS releases MPFS Final Rule, policies governing OPPS/ASC payment systems

Original story posted on: November 4, 2019

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    2020 OPPS Final Rule: New Opportunities, New Compliance Risks

Final Rule covers a wide range of payment and other provisions.

The Centers for Medicare & Medicaid Services (CMS) wrapped up last week by unveiling a final rule associated with the Medicare Physician Fee Schedule (MPFS) and new policies governing the functions of the payment systems for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASCs).

The OPPS Final Rule includes updates of payment policies, payment rates, and quality provisions for services furnished under the MPFS on and after Jan. 1, 2020. The updates include changes to:

Payment Provisions:

  • Rate-setting and conversion factor
  • Medicare telehealth services
  • Evaluation and management services
  • Physician supervision requirements for physician assistants
  • Review and verification of medical record documentation
  • Care management services
  • Medicare coverage for opioid use disorder treatment services furnished by opioid treatment programs
  • Bundled payments under the PFS for opioid use disorders
  • Therapy services

Other Provisions:

  • Quality Payment Program
  • Ambulance services
  • Ground ambulance data collection system
  • Open Payments Program
  • Medicare Shared Savings Program

To review the full fact sheet published Friday by CMS on the MPFS final rule, go online to https://www.cms.gov/newsroom/fact-sheets/finalized-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar.

The OPPS and ASC changes “aim to increase choices, encourage medical innovation, empower patients, and eliminate waste, fraud, and abuse to protect seniors and taxpayers,” CMS said in a press announcement. “The changes build on existing efforts to increase patient choice by making Medicare payment available for more services in different sites of services and adopting policy changes.”

CMS added that it is updating OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.6 percent; the figure is based on the projected hospital market basket increase of 3.0 percent, minus a 0.4 percentage point adjustment for Multi-Factor Productivity (MFP).

The update to ASC rates for 2020 was also listed at 2.6 percent, as CMS noted that it anticipates the move will “also help to promote site-neutrality between hospitals and ASCs, and encourage the migration of services from the hospital setting to the lower-cost ASC setting.”

The final rule associated with these updates, with statutorily required comment period, includes:

  • Increasing choices and encouraging site neutrality
  • Method to control for unnecessary increases in utilization of outpatient services
  • Changes to the inpatient-only list
  • ASC covered procedures list
  • Payment for procedures involving skin substitutes
  • Rethinking rural health
  • Changes in the level of supervision of outpatient therapeutic services in hospitals and critical access hospitals
  • Addressing wage index disparities
  • Unleashing innovation
  • Device pass-through applications
  • Protecting taxpayer dollars
  • Meaningful Measures/Patients Over Paperwork
  • Hospital Outpatient Quality Reporting Program
  • Ambulatory Surgical Center Quality Reporting Program
  • OPPS payment methodology for 340B purchased drugs
  • Partial Hospitalization Program (PHP) rate-setting
  • Update to PHP per diem rates
  • Revision to the organ procurement organization conditions for certification

To review the full fact sheet published by CMS on the OPPS and ASC changes, go online to https://www.cms.gov/newsroom/fact-sheets/cy-2020-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0.

Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade. He can be reached at mcspivey@hotmail.com.

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