The top Medicare changes to know for 2020

As usual, the new year will bring rule changes that affect Medicare documentation, coding and payment.

Here are some of the most important things coming in 2020:

Current Procedural Terminology (CPT) code changes. There are new CPT codes for online evaluation and management (E/M) done through a secure digital platform, such as an electronic health records portal. There are also some new codes for certain meningitis and influenza vaccines and for health behavior assessments and interventions.

Healthcare Common Procedure Coding System (HCPCS) changes. There are new HCPCS codes for chronic care management and principal care management.

Documentation changes. The Centers for Medicare & Medicaid Services (CMS) will begin allowing physicians, physician assistants (PAs), or advanced practice registered nurses (APRNs) who furnish and bill for their professional services to review and verify, rather than redocument, information added to the medical record by physicians, residents, nurses, students, or other members of the medical team in all settings. This applies across all Medicare-covered services paid under the physician fee schedule.

Transitional care management (TCM) expansion. CMS expanded the services that can be reported concurrently with TCM, including prolonged services without direct patient contact, interpretation of physiological data, care plan oversight and others.

Quality Payment Program (QPP) changes. Most of the reforms that start in 2020 are related to the Merit-based Incentive Payment System (MIPS) track of the QPP, not the Advanced Alternative Payment Model. For example, CMS increased the data completeness threshold for quality measures to 70%, and increased the MIPS performance threshold from 30 points to 45 points and the exceptional performance threshold from 75 points to 85 points.

More changes are slated for 2021, when a revision of the E/M office/outpatient visit codes will permit physicians to choose the level of service based on either medical decision making or time (not just face-to-face time) alone. Along with those changes, CMS plans to increase the relative value of those services under the Medicare physician fee schedule and create an add-on code for visit complexity that can be used with most primary care visits. Taken together, that's expected to increase family medicine payments by 12%.

For more on these and other changes, see the full FPM article "The 2020 Medicare Documentation, Coding and Payment Update," published online ahead of print.