Medicare physician payments and quality reporting in 2020: An MGMA analysis of what to expect

The 2020 Physician Fee Schedule Final Rule is now out from the Centers for Medicare & Medicaid Services (CMS). The provisions will take effect on January 1, 2020.

MGMA Government Affairs in Washington, D.C., has prepared an analysis that breaks down significant payment and quality reporting changes for 2020 and offers practical takeaways for busy medical group practice executives.
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This analysis is a member benefit and is available in full only to MGMA members. To become a member and access the full analysis, please visit mgma.com/join.

What is it and why does it matter?

The PFS final rule is a 2,500-page government regulation that dictates payment updates for Medicare services, changes to billing guidance for certain codes, and modifications to reporting requirements under MIPS for CY 2020. While the PFS only applies to Medicare, commercial payers typically follow suit.

Key updates to the 2020 PFS rules

• The CY 2020 PFS conversion factor remains relatively flat at $36.0896. The CY 2020 national average anesthesia conversion factor will be $22.2016.
• In 2021, CMS will maintain separate payment rates for E/M office visits, delete level 1 office visits for new patients, and increase the payment rate for E/M services.
• Payment rates for transitional care management services will increase in CY 2020.
• The MIPS score to avoid a negative payment adjustment in 2022 will increase to 45 points based on performance in 2020.

One key takeaway: Conversion factor

The 2020 PFS conversion factor represents an increase of just a nickel over the 2019 conversion factor, which was $ 36.0391. This modest update continues a concerning trend of relatively flat Medicare payment updates that are not keeping up with the costs of inflation or furnishing care to the intended beneficiaries. MGMA is advocating for Congress to step in and require positive updates to help ensure the financial stability of America’s medical group practices and patient access to quality care.

Other topics covered in the full MGMA analysis

The MGMA report also includes breakdowns and analyses of:

• Changes to E/M services
• Verification of medical record documentation
• PA supervision
• Payment for CCM services
• Establishing new care management services
• Medicare telehealth services
• Consent for communication using technology-based services
• Stark Law advisory opinions
• 2020 MIPS policies
• 2020 Advanced APM policies

MGMA advocates for and strives to provide education on important federal policies to the nation’s medical practices. To support our work and gain access to policy experts, resources and more, please visit mgma.com/join.

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For related information, visit MGMA Government Affairs' Medicare Physician Reimbursement page.