Initial review of the HOPD and ASC proposed regulation include:
- Disclose insurer-negotiated prices and enforcement plan.
- CMS would require hospital websites to display payer-specific negotiated charges for at least 300 “shoppable services” which is defined as a service that can be scheduled by a health care consumer in advance. CMS would designate 70 of the service charges that must be included in the list, and the hospital would have to choose the remaining 230.
- Hospitals that did not comply with the regulations could face a monetary penalty of up to $300 per day until they are in compliance or provide a corrective action plan.
- Changes to Inpatient and Ambulatory Surgical Center Covered Procedure List
- Proposed this year include remove total hip arthroplasty (THA) from the inpatient only list while total knee arthroplasty (TKA) would be added to the ambulatory surgical center services eligible
- Phase-in site neutral payments
- CMS is proposing moving forward with an additional 30% cut. This will bring the national average payment rate will go down from $116 per visit to just $46.
Initial review of the MPFS and QPP proposed regulation include:
- For the second year, implement pricing updates based on market specific supply and equipment prices, malpractice expenses, and geographic-based practice costs.
- CY 2020 PFS conversion factor would be $36.09, a slight increase above the CY 2019 PFS conversion factor of $36.04.
- Moving back to an evaluation and management (E/M) five-tier visit code system for patients and suggested moving to a four-tier coding system for new patients.
- Suggested adapting the revised E/M code definitions developed by the American Medical Association (AMA).
- Adopting the AMAs RUC-recommended payment rates in which CMS would make payments based on each level of service versus single blended rate for codes level 2-4
- Consolidating add-on code for “extended visit” to primary care management that requires comprehensive care as well as for non procedural specialty care that is part of treating complex chronic conditions.
- Requesting comments on changes to global surgery coding
- Increasing Medicare transitional care management payments for clinicians when a patient leaves the hospital
- Changes under QPP’s Merit-based Incentive Payment System (MIPS) in the cost and quality performance category
- Expand Medicare coverage for opioid use disorder treatment services