The Centers for Medicare & Medicaid Services (CMS) recently announced three important Medicare proposed payment rules that support the transformation of the healthcare system and deliver on providing quality care for patients. Additional proposed rules Advance Agency’s Patients Over Paperwork and Meaningful Measures Initiatives, Strengthen Quality Incentives and Build on Commitment to Improving the Lives of Patients with Kidney Disease.
Calendar Year (CY) 2020 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule
CMS is putting forward price transparency requirements that will increase competition among all hospitals by requiring them to make pricing information publicly available. Each year, CMS issues a proposed rule to update CY Medicare payment policies and rates under the OPPS and the ASC Payment System.
Calendar Year (CY) 2020 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) Proposed Rule
This proposed rule updates payment policies for clinicians paid for the services they provide to Medicare beneficiaries under the PFS and QPP. The proposed policy changes will ensure clinicians spend more time providing high-value care for patients instead of on cumbersome paperwork. As part of CMS’s annual changes to the PFS and QPP, the agency is reducing burden, rewarding clinicians for the time they spend with patients, removing unnecessary measures they have to report, and making it easier for them to be on the path towards value-based care. This proposed rule builds on the Trump Administration’s efforts to establish a patient-driven healthcare system that focuses on better health outcomes.
Calendar Year (CY) 2020 Medicare End Stage Renal Disease (ESRD) and Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Proposed Rule
The ESRD and DMEPOS CY 2020 proposed payment rule would update payment policies and rates under the ESRD Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries and the DMEPOS Competitive Bidding Program (CBP) and Fee Schedule Amounts. This proposed rule puts forth updates to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI. The proposal would also make changes to the ESRD Quality Incentive Program (QIP), introduce a methodology for calculating fee schedule payment amounts for new DMEPOS items and services, adjustments the fee schedule amounts established using supplier or commercial prices if such prices decrease within five years of establishing the initial fee schedule amounts, and also revises existing policies related to the competitive bidding program for DMEPOS.