CMS makes corrections to area wage index, other policies for 2020
The Centers for Medicare & Medicaid Services Dec. 31 issued a notice making corrections to the area wage index and other policies contained in its final rule for the calendar year 2020 outpatient prospective payment and ambulatory surgery center payment systems.
For the OPPS, CMS updates the standard wage index conversion factor budget-neutrality adjustment from 0.9990 to 0.9991, which also results in the overall wage index budget-neutrality factor changing from 0.9981 to 0.9982. This correction was necessary because some of the CY 2020 wage indexes used for calculating budget neutrality were based on the incorrect assignment of a rural wage index rather than the rural floor. This changes the conversion factor from $80.784 to $80.793 and the resulting payment files, impact tables and the reporting ratio for hospitals that are not outpatient quality reporting compliant from 0.981 to 0.982. CMS also includes the 5% cap on wage index reductions, which had been omitted. CMS corrects the difference in pass-through spending for 2019 and 2020 to be 0.74 percentage points, not 0.88 percentage points although this was a narrative only error, not one that affects rates. The estimate of drugs on pass-through is $425.6 million, not $339.6 million. CMS also adds codes J0586 and J7588 to the list of codes subject to prior authorization, and assigns codes 99487 (Complex Chronic Care Management without patient visit) and 99490 (Chronic Care Management Services 20 minutes) a status indicator of “S” (separately payable) instead of “B” (not a valid code for the OPPS) and assigns these codes to APC 5822 (level 2 Health and Behavior Services). The add-on code for complex chronic care management (99489) is assigned a status indicator of “N” (unconditionally packaged) rather than “B.”
For the ASC payment system, the ASC conversion factor is changed from $8,383.12 to $8,384.05 as a result of the OPPS payment changes. This results in slight changes to ASC payment amounts and coinsurance for specific procedures like Total Knee Arthroplasty mentioned in the preamble of the rule. It also slightly changes payments for ASC procedures paid under the device intensive methodology. In addition, CMS adds a section on the ASC update for ASCs that meet and do not meet quality data reporting requirements, which was inadvertently omitted from the final rule.