Every January brings Medicare changes that ripple through private practice billing. Here is a breakdown of the most significant 2020 changes and their practical implications.
## 1. Medicare Beneficiary Identifier (MBI) — Full Transition Complete
CMS completed the transition from the legacy Health Insurance Claim Number (HICN) to the new Medicare Beneficiary Identifier (MBI). As of January 1, 2020:
– **All claims must use the MBI.** HICNs are no longer accepted.
– MBIs are unique, randomly generated 11-character codes (no Social Security Number embedded).
– Practices that had not updated their patient records faced claim rejections.
**Action taken:** MedLink clients completed full MBI updates in Q4 2019. If you had ongoing HICN-related rejections into 2020, your eligibility verification process needed revision.
## 2. Opioid Treatment Programs (OTP) Bundled Payments
CMS introduced a new bundled payment model for Medicare-enrolled Opioid Treatment Programs. Under this model, OTPs receive a single bundled payment covering:
– Counseling services
– Toxicology testing
– Medication administration
– Individual therapy
This is a significant structural change for practices involved in opioid treatment, moving away from fee-for-service toward a care-coordination model.
## 3. Part B Premium Changes
The 2020 Medicare Part B premium increased to **$144.60 per month**, up from $135.50 in 2019. While this is a patient-facing cost, it matters for practices because:
– Higher premiums correlate with higher deductibles
– Some patients defer care or reduce appointment frequency when premiums rise
– Patient balance management becomes more important
## 4. KX Modifier Thresholds for Therapy Services
For PT, OT, and speech-language pathology practices, the 2020 therapy cap thresholds were:
– **$2,080 for PT and SLP combined**
– **$2,080 for OT (separate)**
Once a patient’s allowed charges exceed these thresholds, the KX modifier must be appended to each claim to attest that the services are medically necessary beyond the cap. Missing the KX modifier results in automatic denial.
## 5. Therapist Assistant Modifiers
A major change for PT and OT practices: services provided by physical therapist assistants (PTAs) or occupational therapy assistants (OTAs) must now use specific modifiers:
– **CQ modifier** — Services provided in whole or part by a PTA
– **CO modifier** — Services provided in whole or part by an OTA
These services are reimbursed at **85% of the standard rate**. Practices that failed to apply these modifiers faced compliance risk and potential overpayment recovery.
## 6. MIPS Participation Requirements
For practices subject to MIPS (Merit-based Incentive Payment System) in 2020:
– **45 points required** to avoid a negative payment adjustment in 2022
– Reporting required across 2 of 4 categories: Quality, Promoting Interoperability, Improvement Activities, and Cost
– Small practices (≤15 clinicians or ≤$90K in Part B charges) had the option to submit at a reduced threshold
**If your practice is subject to MIPS, the payment adjustments from 2020 reporting apply to 2022 Medicare payments.** It is not too late to review your historical reporting.
## Final Thought
Medicare changes come every year, and each one requires action. The practices that stay ahead are the ones with billing partners who track these changes proactively. If you have questions about how any of these changes affected your practice, reach out to our team.