November 12, 2019 03:36 pm News Staff – The AAFP recently released a summary of the final 2020 Medicare physician fee schedule(3 page PDF) that emphasizes a significant change on the horizon: a payment boost stemming from ongoing Academy advocacy.
Specifically, the combined final rule and interim final rule CMS issued Nov. 1 calls for higher payments for evaluation and management codes and the development of primary care add-on codes, resulting in a 12% increase in total allowed charges for family physicians starting in 2021.
The final 2020 MPFS conversion factor is $36.0896 (2019's was $36.0391), resulting in no change in total Medicare allowed charges for family medicine in 2020.
The Academy had long advised CMS that undervaluation of E/M services slowed crucial investments in primary care. As supported by the AAFP, the final rule aligns E/M coding with changes laid out by the CPT Editorial Panel for office and outpatient E/M visits, starting in 2021. This means that
CMS finalized the adoption of Academy-supported, AMA/Specialty Society Relative Value Scale Update Committee-recommended values for the office and outpatient E/M visit codes for 2021, as well as a new add-on CPT code for prolonged service time, which CMS outlined in a fact sheet also released on Nov. 1.
As outlined in a CMS executive summary of the 2020 Quality Payment Program the Merit-based Incentive Payment System will operate with the following performance thresholds and category weights for the 2020 performance period (which equates to the 2022 payment year):
For the 2021 performance period, however, CMS has raised the performance threshold to 60 points, with the additional performance threshold for exceptional performance remaining at 85 points.
In a move the Academy backed, the 2020 MPFS establishes Medicare coverage for medication-assisted treatment for opioid use disorder.
CMS finalized the creation of new coding and payment for a monthly bundle of services for treatment of OUD that includes overall management, care coordination, individual and group psychotherapy and substance use counseling, as well as an add-on code for additional counseling.
Also on Nov. 1, CMS also issued "Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs" as a final rule with comment period.
The Academy had encouraged CMS in a Sept. 19 letter(2 page PDF) to consider site-of-service payment parity from a broader perspective and to create incentives for services to be performed in the most cost-effective location, such as a physician's office.
The final rule includes a policy that continues to eliminate differential payments between certain outpatient sites of service, completing a two-year phase-in of the move to reduce unnecessary utilization in outpatient services by addressing payments for clinic visits furnished in the off-campus hospital outpatient setting. This could save Medicare beneficiaries $160 million and the Medicare program $650 million in 2020.
However, CMS did not finalize an Academy-backed proposal to require hospitals to disclose prices for all supplies, tests and procedures. A separate final rule on the issue is expected in the future, the agency said.
Related AAFP News Coverage
AAFP Offers CMS Improvements to Proposed 2020 MPFS