As we wrap up 2019, the Centers for Medicare and Medicaid Services (CMS) has released a variety of information healthcare providers need to know about billing Medicare in 2020. We’ve created a short list of the top eight things providers should know.
Medicare Fee Schedule
In November, CMS released the 2020 Medicare Physician Fee Schedule. For a detailed look at some of the provisions that were part of that final rule, check out our blog post, “2020 Medicare Physician Fee Schedule: What You Need to Know.” For a data source of the updated fees for Indiana and Michigan, visit WPS GHA’s webpage of downloadable fee schedules. A zipped file of updated fees for all states is available on the CMS Physician Fee Schedule webpage.
Medicare Part B Premiums
The standard monthly premium for 2020 Medicare Part B will increase from the 2019 rate of $135.50 to $144.60. According to CMS, the $9.10 increase is “largely due to rising spending on physician-administered drugs.”
“These higher costs have a ripple effect and result in higher Part B premiums and deductible,” the agency said in their recent Fact Sheet.
The increases also result from a 1.6 percent cost-of-living adjustment (COLA) announced by the Social Security Administration, which also implements a “hold harmless” provision for Medicare Part B premium increases. In other words, beneficiaries whose COLA to their social security benefit is not enough to cover the increase in the Medicare premium will pay less than the $144.60.
About 7 percent of Medicare beneficiaries pay increased premiums based on a sliding scale of incomes greater than $87,000 per year for beneficiaries who file individual tax returns, or greater than $174,000 for joint filers. Depending on their modified adjusted gross income, beneficiaries might pay as much as $491.60 in monthly premiums in 2020.
These premiums do not apply to Medicare Advantage or prescription drug plans, whose premiums are determined separately.
Medicare Part B Deductible
CMS also announced that the annual deductible for all Medicare Part B beneficiaries will be $198 in 2020 (compared to $185 in 2019). This deductible does not apply to Medicare Advantage or prescription drug plans, whose deductibles are determined separately.
Medicare Part A Premiums
About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $252 in 2020, a $12 increase from 2019.
Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $458 a month in 2020, a $21 increase from 2019.
These premium amounts also do not apply to Medicare Advantage or prescription drug plans.
Medicare Part A Deductible/Coinsurance
The Medicare Part A inpatient hospital deductible for beneficiaries admitted to the hospital will be $1,408 in 2020, up $44 from 2019, which covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. For days 61-90, Medicare beneficiaries will pay a coinsurance amount of $352 per day in a benefit period, and $704 per day for lifetime reserve days.
For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $176.00 in 2020.
These deductibles and coinsurances also do not apply to Medicare Advantage or prescription drug plans.
Changes to Medigap Plans
Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020.
According to Medicare.gov, if beneficiaries already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, they’ll be able to keep their plan. If they were eligible for Medicare before January 1, 2020, but not yet enrolled, they also may be able to buy one of these plans.
MIPS
As the Merit-Based Incentive Payment System (MIPS) enters its fourth year, eligible providers should begin planning to participate in 2020. Not participating in the program in 2020 or failure to meet certain program standards could result in a -9 percent payment adjustment of covered professional services paid under or based on the Medicare Physician Fee Schedule in 2022.
For 2020, providers also have to achieve a threshold of 45 points to be eligible for a bonus, up from 30 points in 2019. And the quality performance category’s data completeness requirements have increased to 70 percent for 2020, up from 60 percent in 2019.
While the Quality Payment Program website is not yet updated to allow providers to determine their eligibility for MIPS in 2020, you can visit CMS’s Quality Payment Program Participation Status page for one last check of your 2019 eligibility to ensure you meet the program requirements for the year about to end.
Also, providers interested in applying for a Promoting Interoperability Hardship Exception or Extreme and Uncontrollable Circumstances Exception for the 2019 Performance Year of MIPS must submit their application to CMS by Tuesday, December 31, 2019.
New Medicare Card
Providers should now be using the new Medicare Beneficiary Identifiers (MBIs) from beneficiaries’ new Medicare cards to avoid claim and eligibility transaction rejects. Starting January 1, 2020, regardless of the date of service on the Medicare transaction, most claims with the old Social Security Number–based Health Insurance Claim Numbers (HICN) will reject with a few exceptions. According to CMS, currently 87 percent of claims are being submitted with the new MBIs.
If providers do not use MBIs on claims after January 1, they will get:
- Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity’s contract/member number), and an Entity Code of IL (subscriber).
- Paper claims notices: Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)” and Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier.”
If patients do not provide their new Medicare cards, providers can still get MBIs through their Medicare Administrative Contractor’s (MAC) portal. The MBI also can be found on the remittance advice.
For more information, review the MLN Matters Number: SE18006 for more information on getting and using MBIs.
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