LogixHealth Releases Review of 2020 Outpatient Payment System Final Rule

BEDFORD, Mass., Feb. 12, 2020 /PRNewswire/ — LogixHealth has released its 2020 Outpatient Payment System (OPPS) Update, a review of the 2020 Outpatient Payment System Final Rule published by the Centers for Medicare and Medicaid Services. The final rule establishes payment rates and policies for outpatient services furnished by hospitals that are paid under the OPPS, and governs services provided on or after January 1, 2020. 

LogixHealth’s 2020 Outpatient Payment System Update indicates that in 2020, CMS is updating OPPS rates by 2.6%. The change is based on the projected hospital market basket increase of 3.0% minus a 0.4% adjustment for multi-factor productivity (MFP) required by the Affordable Care Act. The unadjusted conversion factor under OPPS will increase from the 2019 OPPS conversion factor of $79.490 to $80.784 for 2020. CMS estimates that total payments to OPPS providers for calendar year 2020 will be approximately $79.0 billion, an increase of approximately $6.3 billion over 2019.

For 2020, the composite APC methodology continues to combine ED and observation services into a single APC. For 2020, APC 8011 will reimburse $2,203.35. The observation APC underwent a drastic increase in payment in 2016 related to the extensive packaging associated with the Comprehensive APC construct.

Each year, the OPPS final rule updates reimbursement rates for essential ED services. In particular, with the complex coding rules surrounding the high-frequency hydration, injection, and infusion codes, there is significant revenue at stake for these procedures. According to Elijah Berg, M.D., CEO of LogixHealth, “Significant revenue continues to be dependent on the documentation and coding of infusion services.” A table outlining the 2020 rates is included in LogixHealth’s 2020 Outpatient Payment System Update.

For 2020, there are no significant changes to the rules governing ED facility E/M level guidelines. Per the initial description in the 2008 OPPS final rule, hospitals should utilize their own scoring systems which should reflect facility resource utilization and be consistent with the 11 Guiding Principles published in the 2008 OPPS final rule.

LogixHealth’s 2020 Outpatient Payment System Update and the CMS 2020 Outpatient Payment System Final Rule, can be found on the LogixHealth websitewww.logixhealth.com.

About LogixHealth:
LogixHealth provides expert coding, billing, data insights, and technology solutions for top hospitals, emergency departments and office-based practices nationwide, servicing millions of patient visits annually across over 40 states. LogixHealth offers the tools and resources to optimize financial performance and improve the quality of care. For more information, visit www.logixhealth.com.

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