Medicare Changes for 2020 | How Will They Affect The Private Practice Owner


A new year is upon us which means one thing when discussing medical billing; change.  As per usual, CMS has released the changes that will take place in 2020.  This may seem overwhelming, but have no fear as Medlink Services breaks down many of the upcoming changes in a simple, easy to read format.  Below we discuss a few of the Medicare Changes for 2020 and how to comply with the new guidelines.

Let’s start with one of the simpler changes and one that has been taking place for a few years now.

Member Beneficiary Identifier

Effective January 1, 2020 • All Medicare patients must have an updated Medicare card with the members MBI (medicare beneficiary identifier) number on it. Claims submitted with HICN (health insurance claim number) will be rejected.

Hopefully, this isn’t something new to your office, but it is official as of January 1.  Medicare will no longer be accepting claims using old ID’s.  These Medicare Changes for 2020 were specifically put in to place to cut down on fraud, as the old cards had Social Security Number’s on them.  Who ever thought of putting Social Security Numbers on Medicare Cards should have their head examined!  Having Social Security Numbers on ID cards guarantees one thing, our most vulnerable segment of society; the elderly, was at considerable risk for Identity Fraud.

Be very mindful, According to this AARP article scammers are actively reaching out to Senior Citizens and telling them they need to verify personal information or they need to pay a processing fee to get their card.  This is not the case, if you receive a call like this, it’s a scamDo not provide any personal information, instead, tell them that due to your being in the middle of a pickleball match or at the bingo parlor, ask for their name and number so you can call them back shortly.

If they do provide you with their name and number call CMS, here to verify their authenticity.  If not, do your best to report them.

For providers, you would be serving your patients well by advising them to not discard their old cards unless they are shredded, as they do contain private information.  Also, the 1’s and I’s on the new ID cards are hard to tell a difference, make sure you can discern the two. 

Physician Fee Schedule Changes for 2020

Effective January 1, 2020 • CMS to pay OTPs (Opioid Treatment Programs) through bundled payments for opioid use disorder treatment services for people with Medicare Part B, including medication-assisted treatment medications, toxicology testing, and counseling.

This is a big change for many areas of the country, as we have begun the fight against opioid addiction and their negative side effects.  A disease which takes the lives of nearly 130 people per day in this Country, CMS is now taking action.  CMS will begin to pay for treatment and counseling to those who qualify.  Clinics may obtain full OTP certification from Substance Abuse & Mental Health Services Administration (SAMHSA), enrollment began November 2019.

Changes to the Medicare Part B Premiums & Deductibles

Effective January 1, 2020 • Standard monthly premium $144.60 – Held harmless beneficiaries will have Part B premium increase in 2020 • Annual deductible $198.00 • Coinsurance 20%

These changes are fairly self-explanatory, but be sure to double check all patient’s co-pays and deductibles as the new year is upon us and because of that, Deductibles and Co-pays reset to zero.

Touching base on some new therapy thresholds and modifiers.

Effective January 1, 2020 • KX modifier threshold amounts: –$2,080 for Physical Therapy (PT) and Speech-Language Pathology (SLP) services combined, and –$2,080 for Occupational Therapy (OT) services

Congress passed the Bi-Partisian Budget Act in 2018.  Not much they do these days is “Bi-Partisian”, but we’ll take what we can get.  Per this directive, CMS was to establish a payment differential for services, provided “in whole” or “in part”,  for physical therapist assistants (PTA) and occupational therapist assistants (OTA).  As usual, questions still lingered after this bill was passed, specifically about how the definition of “in Part” will affect reimbursement.

Thankfully, you may say, in 2019 CMS clairified this, and defined “in part” by saying any care that exceeded 10% of the total time of care, fit the definition and would be subject to reduced billing.

Therapist Assistant Modifiers

And….. Beginning January 1, 2020, claims from all outpatient therapy providers, which would include most who are in private practice; Physical and Occupational Therapists must include the CQ (PT), or CO (OT) modifier for services furnished in whole or in part by the respective provider.

Participating in MIPS?

As you may have guessed, CMS didn’t leave this sleeping dog lie.  The number of points needed for the 2022 Incentive Payment has increased from 30 in 2019 to 45 in 2020.  Physical Therapists will also need to participate in 2 of the 4 MIPS Categories, Quality Measures and Improvement Activities.

While these are not the entire list of changes taking place in 2020, the focus of CMS continues to be; Value.  To accomplish Value, CMS has deployed a “Triple Aim” approach.

  • Improving the Patient Experience of Care (including quality and satisfaction).
  • Reducing the Per-Capital Cost of Health Care
  • Bettering the Health of Populations

To maximize the benefits of the Triple Aim approach, CMS needs your Data.  Kinda like the old sign when Uncle Sam points at you and says: I Want You.  Except, this time he’d rather have your Data!

Data in 2020

So, we wholly expect your task of Data Collection in 2020 to increase.  Of course, saying this seems like a “lay up”, or an oxymoron because, when has the need for CMS paperwork ever really decreased?

While delivering a Value-Based approach to Medicine is a noble undertaking, if the providers time and energy used to accomplish this goal is consumed by data collection, then could the costs outweigh the benefits?  This question has always been part of the discussion, and there may come a ‘tipping point’ if we experience a declining number of people who want to be a medical providers because of its paperwork demands, but the amount of patients keeps growing.  Just something to think about going forward.  After all, Providers want to see patients, not 855B’s!

For now, we will make the most of what we’re given with regard to these Medicare Changes for 2020 and as a private practice, do the best we can do, to eke out a profit.  If you need help Eke’ing, feel free to give Medlink Services a call, or drop us a line.

Medlink Services specializes in Claims Billing, Accounts Receivable Management, Consulting and Reporting, and bringing a bit of entertainment to the humdrum subject of the Medical Finances.

 

 

 

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