OPPS and MPFS Final Update for 2020 Including Provider-based status and Telehealth

*This program has the prior approval of AAPC for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Understanding “new technology” ICD-10-PCS codes are critical to hospital revenue. Changes are effective October beginning.
Intermediate to Advanced Level OPPS and MPFS Final Changes for 2020 including provider-based status and telehealth

Both OPPS and MPFS continue to change and evolve.  For MPFS there are significant changes in the offing for E/M coding.  Work continues on eliminating the GSP.  Telemedicine will be a very active area in the next several years.  Provider-based clinics continue as an area of concern.  Implementation of MIPS contuse as do various advanced payment models.  OPPS in the form of APCs, is now being significantly changed.

The final changes for 2020 continue to involve significantly increased packaging in several forms.  Further changes for device dependent APCs along with changes generated to by cost reporting changes.  Besides composite APCs, we now have comprehensive APCs.  These changes started in 2008 and continue to accelerate with particular attention relative to observation services.  Given additional changes for CPT and HCPCS, the impact of changes for APCs are revolutional as opposed to evolutional.  Also, CMS is addressing the physician supervision issue with a major change which will impact both hospitals and physicians.

Expert presenter, Duane C. Abbey, CFP, in 90 minutes webinar, will discuss anticipated future changes and directions for both MPFS and OPPS, alog with many finalized changes for 2020. 

• What is happening to RBRVS?


• Is MIPS really replacing the SGR?


• What is happening to the GSP?


• Why are provider-based clinics such a challenge?


• Where is telemedicine headed?


• What does the increased bundling under APCs mean for our hospital?


• What is happening with observation services?


• How is physician supervision changing?


• What are the general trends for the evolution of APCs?


• How are changes in the cost reporting process affecting APCs?


• What is the difference between composite versus comprehensive APCs?


• What about all of the other payment mechanisms such as cost outliers and copayment amounts?

Session Objectives

• To review the many proposed and finalized changes for MPFS and OPPS for 2020.


• To recognize the general trends for both MPFS and OPPS with particular attention to payment impacts.


• To understand MIPS, the SGR and advanced payment models being promulgated by CMS.


• To appreciate activities and anticipated changes for telehealth in the coming years.


• To appreciate changes made relative to observation services, associated packaging and the need for special billing for packaged items that are not normally paid through APCs.


• To understand how recent changes in the cost reporting process affect APCs payments.


• To understand the complex nature of MPFS and OPPS and associated compliance issues including RAC concerns.


• To review changes in grouping with particular attention to new CPT and HCPCS codes.


• To appreciate the potential financial and operational impact of the proposed changes.


• To review the possible impact of the proposed change on high impact areas such as observation, the Emergency Department, interventional radiology and associated areas.


• To review changes to and trends for the Provider-Based Rule (PBR) and the implementation of Section 603 of BiBA 2015.


• To appreciate the changes that CMS is making in the physician supervision area.

Session Agenda And Highlights

• Review of MPFS Final Changes for CY2020
  
  
  
  1. Changes of RBRVS
  
  
  2. E/M Coding Guidelines
  
  
  3. MIPS, SGR And the Conversion Factor
  
  
  4. Elimination of GSP
  
  
  5. Telehealth Directions and Anticipated Changes
  
  
  6. Advanced Payment Models
  
  
  7. Physician Supervision – Changes
  
  
  8. Other Changes and Considerations
  
  
  
  
• Review of APC Final Changes for CY2020
  
  
  
  1. Coding/Grouping Changes
  
  
  2. E/M Coding
  
  
  3. Recalibration of APC Weights
  
  
  4. On-Going Problem Areas
  
  
  5. Drugs and Biologics
  
  
  6. Cost Outliers
  
  
  7. Interventional Radiology
  
  
  8. Additional Comprehensive APCs
  
  
  9. Inpatient-Only Procedures
  
  
  10. Physician Supervision
  
  
  
  
• Provider-Based Clinic Changes
  
  
  
  1. CMS Information Collection
  
  
  2. BiBA 2015 – Section 603 Implementation
  
  
  3. Service Lines and Equalization of Payment
  
  
  4. Projecting the Future for Provider-Based Clinics
  
  
  
  
• Associated Proposed MPFS and OPPS Changes
  
  
  
  1. Ambulatory Surgery Centers
  
  
  2. Related Physician Changes
  
  
  3. Clinical Service Area Considerations
  
  
  4. RAC Audit Concerns
  
  
  
  
• Assessing the Impact of Proposed Changes - Financial, Coding and Billing Impacts, Operational Impacts, APC Compliance Issues


• The Future for RBRVS and APCs

Who Should Attend

• Clinic Coding Personnel, Outpatient Clinical Staff


• Physicians, and Practitioners


• Nurse Auditors, ED Nursing Staff, Provider-Based Clinic Nursing Staff


• Outpatient Departmental Managers


• Coding Personnel, Coding, Billing and Claims Transaction Personnel


• Internal Auditing Personnel, Compliance Personnel


• Revenue Cycle Specialists


• Financial Analysts, Cost Accounting Personnel


• Cost Reporting Personnel


• Chargemaster Coordinators


• Other Interested Personnel

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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