On November 1, 2019, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020. These policies impact care for residents at skilled nursing facilities (SNFs) and assisted living residences (ALRs) in several ways, including services furnished by physicians, therapists, and other suppliers of Medicare Part B services. AHCA/NCAL has prepared a summary of the final rule and the impact on SNF and ALR providers (member log-in required).

The CMS Physician Fee Schedule Fact Sheet and PFS Quality Payment Program Fact Sheet provide summaries of the major provisions. The official final rule is expected to be published to the Federal Register on November 15.

Here’s what providers need to know under Part B effective January 1, 2020. 

• The CY 2020 PFS conversion factor is $36.09, a slight increase of $0.05 above the CY 2019 PFS conversion factor.
• The estimated net impact on CY 2020 Medicare Part B therapy service payments is 0.0 percent.
• CMS finalized Medicare Part B therapy service claim coding and documentation policies advocated by AHCA/NCAL associated with the reporting of occupational therapy assistant (OTA) and physical therapist assistant (PTA) services for dates of service beginning January 1, 2020. More details are available in the AHCA/NCAL summary.
• CMS finalized major changes to physician Evaluation and Management (E&M) payment policies that could impact therapy payments beginning CY 2021, but additional stakeholder advocacy and CMS analysis is needed prior to the CY 2021 rulemaking.

AHCA/NCAL will post updated information related to the finalized therapy assistant coding policies, as well as the CY 2020 Medicare Part B therapy fee schedules in the coming weeks. Please contact Dan Ciolek, AHCA Associate Vice President, Therapy Advocacy, with any questions.