Issue link: https://beckershealthcare.uberflip.com/i/1161749
20 CFO / FINANCE CMS pitches 3 sweeping payment rules for 2020: 10 things to know By Ayla Ellison C MS released three proposed rules on July 29, which include payment updates for outpatient and physician services and expanded price transparency initiatives. Ten takeaways from the proposed rules: Medicare Outpatient Prospective Payment System 1. Payment update. CMS proposed increasing the OPPS payment rates by 2.7 percent in 2020 compared to 2019. e agency estimates total payments to OPPS providers will be roughly $6 billion higher in 2020 than this year. 2. Price transparency. e proposed rule builds on previous price transparency guidance from CMS by defining "stan- dard charges" to include the hospital's gross charges and payer-specific negotiated rates for an item or service. Hospitals would be re- quired to publish all standard charges online in a machine-readable file. In addition, the rule would require hospitals to publish pay- er-specific negotiated rates for 300 services consumers are likely to shop for, including 70 defined by CMS, in a searchable and consum- er-friendly manner. Hospitals that fail to pub- lish the prices could be fined up to $300 a day. 3. Site-neutral payments. e proposed rule would finish phasing in a policy adopt- ed last year to make payments for clinic vis- its site-neutral by reducing the payment rate for hospital outpatient clinic visits provided at off-campus provider-based departments. ese off-campus departments would be paid at a rate of 40 percent of the OPPS rate in 2020. 4. Inpatient only list. e proposed rule would remove total hip arthroplasty from the inpatient only list, making it eligible to be paid by Medicare in both the inpatient and outpatient setting. Medicare Physician Fee Schedule 5. Payment update. CMS proposed increas- ing physician payment rates by 0.14 percent in 2020. Aer applying the budget-neutrality adjustment required by law, CMS estimated the 2020 Physician Fee Schedule conversion factor is $36.09, up from $36.04 in 2019. 6. Evaluation and management coding and payment. Under the proposed rule, separate payment rates would be set for all five levels of coding for evaluation and management visits. 7. Medical record documentation. e pro- posed rule would allow physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse-midwives to re- view and verify information in a patient's med- ical record that is entered by other clinicians, rather than re-entering the information. 8. Telehealth services. CMS proposed add- ing a set of codes, which describe a bundled episode of care for treatment of opioid use disorders, to the list of telehealth services covered by Medicare. End Stage Renal Disease Prospective Payment System 9. Payment update. CMS expects to pay rough- ly $11.1 billion to approximately 7,000 end- stage renal disease facilities for providing dial- ysis services in 2020. at's about $210 million higher than total expected payments in 2019. 10. New and innovative equipment and supplies. Under the proposed rule, CMS would provide a transitional add-on payment adjustment for new and innovative equip- ment and supplies. To qualify, equipment and supplies must be granted marketing autho- rization by the FDA on or aer Jan. 1, 2020, meet substantial clinical improvement crite- ria and have a healthcare common procedure code system application submitted. n Hospital groups speak out against price transparency in OPPS rule By Emily Rappleye T he country's major hospital associations called a pro- posed CMS rule that would require hospitals to dis- close payer-specific negotiated rates "a misguided attempt to improve price transparency." The new price transparency requirements were included in the 2020 Outpatient Prospective Payment System rule, which was issued July 29. The rule expands on previous price transparency efforts under the Trump administration, which require hospitals to list standard charges online. The new rule expands the definition of "standard charge" to in- clude gross charges and the payer-specific negotiated rates. "Hospitals and health systems want to ensure that pa- tients have access to information they need to choose their healthcare, including their out-of-pocket obligations," said a joint statement from the American Hospital Asso- ciation, America's Essential Hospitals, the Association of American Medical Colleges, the Children's Hospital As- sociation and the Federation of American Hospitals. "This rule, however, is a misguided attempt to improve price transparency for patients because it fails to give [patients] the information they need." Under the proposed rule, hospitals will be required to post negotiated rates by payer in a consumer-friendly way for 300 "shoppable" services. Shoppable services are defined as elective, nonurgent procedures. CMS will dictate 70 of the shoppable services and hospitals can choose the re- maining 230. CMS believes the shoppable services list will help consumers more easily price-shop for care. "Disclosing the negotiated rate between insurers and hospi- tals will not help patients make decisions about their care," the hospital associations said. "Instead, this disclosure could harm patients by reducing patient access to care. This is the wrong approach to price transparency, and the administra- tion should reverse course on this provision." n