News - Latest Rules & Legislative Updates

What to Watch in 2020

As is usually the case at the beginning of a year, health care providers can expect new rules and regulation changes from the Department of Health and Human Services.

Recently, there has been significant policymaker focus on the issues of price transparency, health IT and the Final Rule from the Centers for Medicare & Medicaid Services regarding the Medicare Physician Fee Schedule (MPFS).

Here’s a look at some of the changes you’ll want to know about.

CMS Promotes "Interoperability" Program

The landscape of health IT is constantly changing. With the introduction of many new technologies and updates, staying current with interoperability can be difficult.

CMS plans to replace Meaningful Use with “Promoting Interoperability.” The meaningful use Electronic Health Record (EHR) incentive program served the purpose of getting hospitals to implement electronic health records platforms.

Now, the program is focused on promoting interoperability and the next phase is to advance the federal government’s approach to enabling those organizations to share health data more effectively. 

The main goal of highlighting interoperability as a fundamental feature is to ensure that hospitals and other providers are technologically equipped to help create a seamless flow of health data information between themselves and patients.

Four objectives are the focus of this program:

1. Electronic Prescribing
2. Health Information Exchange
3. Provider-to-Patient Exchange
4. Public Health and Clinical Data Exchange

For more information, see CMS - Promoting Interoperability Programs.

CMS Final Rule for Physician Practices

CMS has issued its Final Rule regarding physician practices. This rule updates payment policies, rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (MPFS).

Coding Changes

This year, there are 273 additions to ICD-10-CM, 21 deletions, and 30 revisions including revisions to atrial fibrillation, diseases of the lymphatic system, pressure ulcers and congenital diseases that were effective October 1, 2019.

In addition, the CPT (Current Procedural Terminology) features 394 changes; 248 new codes, 71 deleted and 75 revised including 6 new codes for online digital visits, long term EEG, self-measured blood pressure.

Medicare Physician Fee Schedule

CMS proposed increasing physician payment rates by 0.14 percent in 2020. After 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.

Scope of Practice

CMS also has issued the “Physician Supervision for Physician Assistant (PA) Services” proposal, implementing CMS’ reinterpretation of a Medicare law that requires physician supervision for Physician Assistants’ (PA) professional services.

“Federal Regulations require that PAs must furnish their professional services in accordance with State law and State scope of practice rules that are specific for the State in which the services are furnished, to the extent that those rules describe the required relationship between physicians and PAs. That includes a form of supervision for Medicare purposes,” says Houston-based CPA and medical practice consultant Reed Tinsley.

Medical Record Documentation

The Final Rule also hopes to reduce the burden of paperwork on physicians and other clinicians by implementing a general policy that will allow all Physicians, Physician Assistants (PAs), Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Certified Nurse Midwives (CNMs) and Certified Registered Nurse Anesthetists (CRNAs), each of whom are recognized as Advanced Practice Registered Nurses (APRNs) to review and verify by signing and dating documentation in medical records without having to re-document notes the medical record includes.

This principle applies to all Medicare-covered services that are professional disciplines paid under the MPFS.

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Price Transparency Rules Require Public Pricing Information

The government wants to ensure that all Americans have the information they need to get an accurate estimate of the cost of the healthcare services they are seeking before they receive care. On November 15, 2019, two rules were issued -- one in final form and one in proposed form, designed to increase price transparency in health care.

The rules follow the Executive Order announced on June 24, 2019, directing HHS to adopt regulations improving price and quality transparency, and implement statutes added by the Affordable Care Act.

The two rules issued are:

• 2020 Outpatient Prospective Payment System and Ambulatory Surgery Price Transparency Requirement for Hospitals to Make Standard Changes Public (Final Rule) which requires hospitals--even non-Medicare and non-Medicaid hospitals--to make public their “standard charges” (which includes rates negotiated with third parties). The underlying premise is that price transparency will allow patients to be better informed and then lead to more efficient markets by promoting choices and competition. CMS Fact Sheet
• Transparency in Coverage (Proposed) directs health insurers and group health plans to make available to patients any negotiated rates with in-network providers and its out-of-network pricing. The purpose of the Proposed Rule is to provide transparency that the proposed federal agencies believe promotes choice and competition and allow patients to be active consumers. CMS Fact Sheet

"This transparency announcement may be a more significant change to American healthcare markets than any other single thing we've done, by shining light on the costs of our shadowy system and finally putting the American patient in control.”, said HHS Secretary Alex Azar in an HHS press release.

Despite the mandate, however, some industry experts are skeptical the efforts will meaningfully lower prices for patients without a more fundamental system overhaul.

Stay tuned for next week's update when we provide a little more clarity on what these announcements could mean for health care providers and insurance plans. Be sure to subscribe to Revenue Cycle Matters for healthcare billing best practices and industry tips!