CMS and ASC Changes to Come in 2020

Medical Coding


As we are sure most healthcare providers come to expect, each new year brings new changes to codes, payment policies, and processes in the healthcare industry. On November 1st, CMS announced upcoming changes to payment policies, which were detailed in its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule. The final rule included many new details on processes that healthcare providers should be aware of, and at Healthcare Information Services, we want to keep you up to date so your practice can move confidently into the new year. Below, we have provided more details on some of the main points of the final rule. Keep reading to learn more and get informed so you can be as prepared as possible to adapt to these new changes.

Total Knee Arthroplasty Changes

Under the new regulations, CMS stated that total knee arthroplasty will be eligible for Medicare payment in the ASC setting in 2020. This was not the first change regarding this particular procedure in 2019 – in August, CMS proposed a payment rate of $8,639.97 for total knee arthroplasty in its 2020 outpatient and ASC prospective payment system proposed rule. Along with total knee arthroplasty, knee mosaicplasty, six coronary intervention procedures, and 12 procedures with new CPT codes were added to the ASC-payable list. Being aware of changes to codes is essential as we move into 2020, so be sure that each member of your practice who handles coding is aware of any recent changes that were made.

Hospital Market Basket Updates

The hospital market basket update for ASC payment rates will continue to be used by CMS through 2023 – payment rates that meet certain requirements will increase by 2.6%. Increases under the market basket update will occur for payment rates that meet relevant quality reporting standards. CMS stated that this particular update will “promote site-neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower-cost ASC setting.” 

Going along with the quality reporting factor stated above, ASCs must meet certain quality reporting requirements in order to avoid a 2% fee schedule reduction. No measures were removed in the final rule, but one claims-based measure was added. 

Site-Neutral Payment Policy

In order to reduce “unnecessary utilization in outpatient services,” the final rule includes a site-neutral payment policy that eliminates payment differences between hospital outpatient settings and physician office settings. This accompanies a 2-year phase-in that is designed to lower copayments for beneficiaries. This move is estimated to save Medicare around $800 million in 2020.

Professional Insights

ASCA CEO Bill Prentice said that these changes indicate CMS’ confidence in the ability of physicians to properly move eligible patients to an ASC setting, following established criteria. He said, “We are grateful that this proposed rule continues the sound policy of updating ASC Medicare payments for inflation on par with hospital outpatient departments.” He also expressed satisfaction towards the proposition to add total knee arthroplasty to the procedures list shortly after moving it from the inpatient-only list, because this “speaks well to the confidence that CMS has in the ability of physicians to use well-established patient selection criteria to the lower-cost ASC setting.” Moving forward, it is likely that these changes will benefit both medical providers and patients seeking certain procedures. 

Get Healthcare Practice Guidance from HIS

At Healthcare Information Services, we understand that it can be difficult to stay updated on the latest changes that occur in all corners of the medical industry. We strive to keep providers and practices up to date so that both them and their patients can benefit, and we want to work with you! We offer a variety of services, including revenue cycle management, coding education & analysis, practice management & consulting, and more, to Orthopedic and Radiology practices around the country.  We take care of managing the lifeline of your business so you can focus on what’s most important- your patients. Please contact us today to learn more about all that we can do for you and your practice.