New Medicare Changes Will Increase Your Practice Revenue by 20%

PracticeForces BlogMedical Billing

The changes in Medicare’s physician’s payment fee schedule (PFS) for 2020 have come into effect from January 1st, 2020. In case you missed the updates or are struggling to understand the impact of these changes for your medical practice, we have broken them down for you.


As always, there is good news and bad news.  But the way we see it, if you manage the billing processes of your medical practice effectively, you have far more to gain than lose with the new changes in the PFS.

MINUSCULE CHANGE IN THE PFS CONVERSION FACTOR   

The bad news first – the 2020 PFS conversion factor (36.0896) represents an increase of just a nickel over 2019 (36.0391). The modest hike, unfortunately, continues a concerning trend of relatively flat Medicare payment rates that are not keeping up with the cost of inflation or furnishing care to Medicare beneficiaries.  

While that’s a disappointing increase in the conversion factor, we are optimistic about the revenue enhancement benefits your medical practice could derive from some of the other changes. Now for the good news


Podcast by Kunal Jain and Holly Vogt CPC on Medicare reimbursement in the year 2020

Here are the key takeaways from the new rules that take effect in 2020 MGMA has published a recent article about it which can be accessed here.

MULTIPLE OPPORTUNITIES TO ENHANCE YOUR REVENUE

1. Easier documentation process: In the earlier system, physicians had to create paperwork that the PA had already done. Under the new guidelines, your physician assistant (P.A) or nurse can prepare the patient documents, and you can simply review and verify the document. So, if you see an average of twenty patients a day and spend at least five minutes preparing the documents for each case, the new provision will free up hundred minutes a day; that’s time you can focus on attending more clients and/or delivering better quality care.  (Caveat: P.A’s can only create documents for existing conditions).

2. Principal care management (PCM):  PCM is a new opportunity for billing specialized care cases where there has been either an exacerbation of existing medical condition and the patient is referred to the hospital, or if you see the patient when they come out of the hospital. Under the new guidelines, you can bill for clinic visits for either of the two circumstances.

3. Transitional care management (TCM): The restrictions on concurrent care billing for patients referred for hospitalization, have been reduced.  So there are going to more opportunities for billing. Under existing policy, transitional care management (TCM) services cannot be billed concurrently with 57 codes during the 30-day period covered by TCM. Starting 2020, CMS will allow TCM billing with 16 codes previously prohibited from concurrent billing. These include prolonged services without a direct patient contract and chronic care management. Additionally, CMS increased the payment by adopting the AMA RUC recommended work RVU of 2.36 for CPT code 99495 and 3.10 for CPT 99296 from 2.11 and 3.05 in the year 2019 respectively. For groups already billing for CCM services, the addition of the new add-on code 99490 for noncomplex CCM 20-minutes, should offer additional reimbursement opportunities. CMS also finalized new coverage with a new code describing “Principal Care Management” (PCM) which is similar to CCM but instead is intended for patients with only one complex chronic condition. Starting Jan. 1, 2020 G2064 can be billed for PCM.

4. Telehealth consultation for Opioid-dependency – Patient consultations via Telehealth for Opioid dependency issues can now be billed as in-person consultations. Remote consultation is a great opportunity for physicians to treat opioid-dependent patients who often find it difficult to keep office-appointments. At the same time, this service will result in higher patient outreach and ultimately lead to higher revenue for your medical practice.  

The inclusion of three new codes G2086, G2087, and G2088 will help in expanding access to telehealth for individuals with substance use disorders. 

IMPORTANT OPERATIONAL CHANGES

1. Level 1 is going away in 2021. So ensure that your billing staff is up-to-date on this change and that the EHR vendor updates the medical billing software.

2. Picking the level of service has been simplified. Instead of the medical history and exam of the patient, you can now raise invoices based on ‘time’ and ‘ the amount of medical decision making’ involved. For physicians, this means that they can now bill basis the quality of care rather than the cost of care.

3. Patient I.D has changed from the patient’s social security number to an 11-digit number. Ensure that you collect a copy of the patient’s new Medicare card and that you update this information in the EHR before the patient’s visit, or during the visit at the reception desk in your office. Continue to check the scrubs for any front-end denials due to this change.  

4. An 85 percent performance on the MIPS (merit-based incentive payment system) will allow you an opportunity to earn an additional 19 percent more from Medicare. The performance threshold to avoid a payment penalty is 45 points and the exceptional performance threshold is 85 points. By statute, the 2022 payment adjustment (based on 2020 performance) is +/- 9% while the 10% for exceptional performance will still be available. So here you have an opportunity to make an additional 19% more on Medicare beneficiary if your performance is 85 points.

SO WHAT DO PHYSICIANS NEED TO DO?

1. First and foremost, ensure that your billing staff is trained on the elimination of Level-1 and picking the level of service based on patient- care duration and amount of decision making involved.

2. Connect with your EHR vendor for necessary changes in software as well as for a deeper understanding of how the 2020 Medicare PFS impacts your practice. 

3. Proactively connect with your patients to collect the new Medicare I.D number.

4. Track customer I.D rejections and resolve them on the system.

5. Publicize your ability to offer remote consultation for opioid dependency cases.

6. Adopt technology to improve opportunities for revenue generation. Start Telemedicine visits, Use your software inbuilt eligibility verification to reduce errors at the front end. Use text reminders about payments to patients, enable accepting mobile payments in your medical practice. 

7. Plan to schedule more patients per day as you benefit from the ease in physician-documentation requirements. Text them appointment reminders in advance using the updated EMR or third-party tools.

Watch our podcast above for more information on changes in Medicare PFS.

If you need any assistance in understanding the 2020 Medicare changes and how you can enhance revenue from making changes in your billing processes, we would be happy to help. 

Contact us today for a free two-hour consultation

Kunal Jain is the co-founder of PracticeForces Medical Billing and IT consulting company in Clearwater, Florida.