Summary of Final 2020 Medicare Physician Payment and Quality Reporting Changes - MJM Advisory and Educational Services - Medicare, Physicians

We’ve put together an overview of the final 2020 physician payment and quality reporting changes. 

  1. Physician Payment Update
    • The 2020 Medicare Physician Fee Schedule (PFS) conversion factor is $36.0896. This is an increase compared to the 2019 PFS conversion factor of $36.0391.
    • The anesthesia conversion factor for 2020 is $22.2774, up slightly from the 2019 conversion factor of $22.2730.
  2. E/M Services
    • The are no significant updates to E/M coding, payment or documentation for CY 2020.
    • The CY 2021 policies only apply to office/outpatient E/M visits.
    • Beginning on January 1, 2021 clinicians will select the appropriate E/M level based on either: (1) medical decision making in the exam or (2) time personally spent by the reporting practitioner on the day of the visit (including face-to-face and non-face-to-face).
    • CMS will maintain separate payments for all new and established visits.
    • Beginning in CY 2021, CMS will eliminate level 1 visits for new patients (CPT code 99201) since the only differences between level 1 and level 2 visits for new patients are related to history and exam.
  3. Verification of medical record documentation
    • Beginning  January 1, 2021, CMS will allow physicians, physician assistants (PAs), and advanced practice registered nurses (APRNs) who furnish and bill for their professional services to verify, rather than re-document, information included in the medical record by members of their medical team.
  4. PA Supervision
    • Starting in 2020, CMS finalized a modification to PA supervision policy to permit PAs to practice in accordance with state law supervisory rules, rather than Medicare’s general supervision requirements. In the absence of state law outlining PA supervision, supervision requirements for Medicare will be met when the PA has a working relationship with one or more physicians to supervise the delivery of healthcare services.
  5. Payment for Transitional Care Management (TCM) services
    • Starting in 2020, CMS will allow TCM billing for 16 codes previously prohibited from concurrent billing, such as prolonged services without direct patient contact and chronic care management (CCM) services. Visit bit.ly/TCM-Codes2020 for a listing of the 16 codes.
  6. Payment for CCM Services
    • Starting in 2020, CMS finalized a new add-on code to account for additional time spent on non-complex CCM services (G2058). G2058 can be billed for additional 20-minute increments with a maximum of two times during a given service period.
  7. New Care Management Services
    • Starting January 1, 2020, a new code describing principal care management (PCM) services, which are like CCM services but for patients with only one chronic complex condition (G2064).
  8. Medicare Telehealth Services
    • Effective January 1, 2020 CMS will add three new telehealth codes that describe a bundled monthly episode of care for treatment of opioid use disorders, including for care coordination, individual therapy, and group therapy (G2086; G2087; G2088).
  9. Patient consent for telecommunications-based technology services
    • In the 2020 PFS, CMS finalized a policy to permit a single advanced beneficiary consent for multiple communication-based technology and consultation services that will cover a one-year period.
  10. MIPS score and payment adjustments
    • For the 2020 performance year there will be four performance categories: (1) quality (45%); cost (15%); promoting interoperability (25%); and improvement activities (15%).
    • Eligible clinicians and group practices must earn at least 45 points in 2020 to avoid a Medicare payment penalty of up to 9% in 2022. CMS estimates that the maximum payment adjustment in 2022 to be 6.2%.
  11.  2020 Advanced APM Policies
    • To become a Qualifying Participant (QP), a clinician must receive at least 50% of Medicare Part B payments or see at least 25% of Medicare beneficiaries through an Advanced APM entity.
    • A partial QP must receive at least 40% of Medicare Part B payments or see at least 25% of Medicare patients through an Advanced APM entity. All clinicians who become partial QPs may choose whether to participate in MIPS.
  12. PFS CMS Fact Sheet 2020 can be accessed here

If you have any questions, please reach out to me; I’m happy to discuss.


Michael McLafferty CPA, MBA, FACHE, FHFMA, FACMPE
Chief Executive Officer and Founder
MJM Advisory and Educational Services, LLC
michael@mjmaes.com
https://mjmaes.com
cell – 732-598-8858