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Adjusting to Medicare Changes in 2020

Wednesday, January 8, 2020 9:00 AM

Billing, Coding & Compliance

Written by: Patricia Kennedy

Patricia Kennedy
Senior Consultant

The start of a new year evokes both a reflection of progress that’s been made and a vision of future success. For eye care practices, this annual event also entails new rules and regulations that must be considered during the business planning process.

Specifically, ophthalmic practices must consider how recent Medicare coding and reimbursement updates released by the Centers for Medicare and Medicaid Services (CMS) will impact practice revenue. To simplify planning for the year ahead, we’ve outlined a few significant Medicare changes and related tools developed by BSM that can assist your practice in this endeavor.

2020 Fee Schedule Amendments

Effective Jan. 1, 2020, the Medicare Physician Fee Schedule (PFS) includes updates to payment policies, payment rates, and quality provisions for services furnished. As part of this initiative, CMS added new codes related to cataract surgery that eye care practices should be aware of, including:

66987, Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patient in the amblyogenic developmental stage; with endoscopic cyclophotocoagulation; and

66988, Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation.

While these two codes have yet to be assigned a national payment rate, adjusting your fee schedule for other relevant changes ensures accurate reimbursement. The adjustment process itself can be quite tedious, and to help you, BSM has created the Medicare Payment Rates (MPR) tool for eye care providers and ambulatory surgery centers (ASCs). This tool, which is compatible with most electronic practice management (EPM) systems, can seamlessly integrate a practice’s reimbursement rate data directly into its EPM.

This easy-to-use Excel document incorporates geographic adjustments into your individualized MPR, ensuring each code corresponds to the values published by your Medicare Administrative Contractor (MAC). Additionally, the MPR tool contains the following features:

  • Professional allowables for visits (including diagnostic tests and minor and major surgeries),
  • “Eye Care-only” allowables for the coming year,
  • Global fee periods, and
  • Multiple services indicators.

Furthermore, this tool is easily searchable, allowing billing staff who encounter a “random” eye care code to quickly reference the code and its associated Medicare allowable.

Declining Reimbursement Effects

In the new year, there are a few significant cuts to Current Procedural Terminology (CPT) reimbursement, most notably in cataract surgery. These reductions are largely due to the loss of a post-operative visit included in Medicare's overall payment for cataract services. As announced by CMS, the affected national codes include: 

66984, Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation, is now a $557.58 Medicare allowable, down from $654.47, resulting in a drop of $96.89 per case.

66982, Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation, is now a $765.10 Medicare allowable, down from $813.04, resulting in a drop of $47.94 per case.

For busy cataract facilities, these changes indicate a significant decrease in surgical revenue. As a result, we encourage practices and ASCs to be more efficient, as well as explore additional services that may help to recoup this potential loss.

To better understand the financial impact these changes may have on your practice, BSM is offering a free, downloadable 2020 Medicare Reimbursement Impact Calculator. This Excel tool was created to quickly analyze the impact 2020 Medicare reimbursement changes — including certain procedures like cataracts — could have on your profitability and revenue stream. Results are based on a select list of CPT codes, with the difference between Medicare allowables in 2019 and 2020 based on billing frequency.

Be Proactive

Regardless of the changes that inevitably come with each new year, it’s incumbent upon administrators and management to stay abreast of changes in coding and reimbursement that will affect your bottom line. Being proactive and planning accordingly will better equip your practice to manage and modulate potential negative effects to your business.

LEARN MORE: Visit our Medicare Payment Rates tool and Medicare Reimbursement Impact Calculator pages to help you get ahead in 2020. Direct questions to support@bsmconsulting.com or call 1-800-832-0609.

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