Medicare Issues Final 2020 Outpatient Payment Policies

November 8, 2019

Medicare Issues Final 2020 Outpatient Payment Policies

The Centers for Medicare & Medicaid Services (CMS) has issued final hospital outpatient department payment policies for calendar year 2020, which begins on January 1. Among the range of payment changes and updates, CMS finalized policies to speed-up coverage for breakthrough medical technologies, equalize payment levels among different sites of care, and allow more types of procedures to be performed in ambulatory surgical centers.

Highlights:

Breakthrough Technologies: For medical technologies that FDA has given “breakthrough device” designation, CMS will allow pass-through payment without insisting that they demonstrate “substantial clinical improvement.” This change is consistent with changes CMS made in pass-through payment for such devices in the inpatient hospital setting
Site-Neutral Payments: CMS says it will complete its two-year phase-in of site-neutral policies that will pay for clinic visits at off-campus, provider-based facilities at 40% of the level such visits would be paid if performed in actual hospital outpatient departments. This policy removes the previous exemption from such cuts for some off-campus facilities. A federal judge recently ruled that CMS did not have authority to make such changes, so it is unclear what the result will be.
Procedures Performed in ASCs: CMS will expand the number of procedures that it will pay for when provided at ASCs, including total knee replacement, percutaneous transluminal coronary angioplasty, and percutaneous transcatheter placement of stents.
Payment Rates: CMS will increase both the hospital outpatient department payment rate and the ASC payment rate by 2.6%.
Price Transparency: CMS had proposed that all U.S. hospitals must make prices publicly available annually, including prices negotiated with payers for at least 300 “shoppable” services that consumers can schedule in advance. CMS said it is still reviewing comments on the proposal and will address it in a separate final rule.

CMS fact sheet