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Medicare: Proposed and Final Rules

In early November, the Centers for Medicare and Medicaid Services (CMS) released two final rules for the calendar year (CY) 2020 Medicare payment system.

Hospital Outpatient Prospective Payment

The Agency received over 3,400 response to the Proposed Rule and is moving forward to finalize rules to:

  1. Refine the requirements for the Hospital Outpatient Quality Reporting (OQR) and ASC quality reporting (ASCQR) programs;
  2. Establish a process and requirements for prior authorization for certain covered outpatient department services;
  3. Revise the regulations to allow grandfathered children’s hospitals-within-hospitals to increase the number of beds without resulting in the loss of grandfathered status.
  4. Provide notice of the closure of two teaching hospitals and the opportunity to apply for available slots for IME and DME payments.

Hart Health Strategies: Comparison of the CY 2020 Proposed and Final Rule

Medicare Physician Fee Schedule

This final rule addresses changes to the physician fee schedule and other Part B policies to ensure payment systems are updated to reflect changes in medical practice and the relative value of services. Unless otherwise indicated, these regulations will be effective 1-1-2020.

Hart Health Strategies: Comparison of the CY 2020 Proposed and Final Rule