Coding and Billing

Setting Your Fees for 2020 to Be More Profitable

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

Nov. 6, 2019

It’s the time of year to begin thinking about your fees for the next year. One place to start is to look at the Medicare Physician Fee Schedule Final Rule for next year.

The CY 2020 Medicare Physician Fee Schedule Final Rule was placed on display at the Federal Register on November 1, 2019. This final rule updates payment policies, payment rates and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2020.

In addition to policies affecting the calculation of payment rates, this final rule identifies potentially mis-valued codes, adds procedures to the telehealth list and finalizes a number of new policies.1

The final rule went on display at the Office of the Federal Register’s Public Inspection Desk on November 1, 2019, and will be available until the regulation is published on November 15, 2019. The comment period will close on December 31, 2019.ii

You can find the entire list of final rules HERE.iii

Not all of the Medicare Physician Fee Schedule Final Rules apply to eyecare providers. But you should be thinking about the ones that do apply to us.

Two of the final rules you should consider are:

CY 2020 PFS Final Rule Physician Time [ZIP, 645KB]

CY 2020 PFS Final Rule List of Telehealth Services [ZIP, 12KB]

Additionally, the Diagnostic Ophthalmology Services Subject To The Multiple Procedure Payment Reduction CY 2020 is helpful. This is nested within the next document:

CY 2020 PFS Final Rule Multiple Procedure Payment Reduction Files [ZIP, 44KB]

Once within this document, open excel spreadsheet file CMS-1715-F_CY2020_Diagnostic Ophthalmology Services Subject to MPPR to find this information.

With that background, let’s get to the heart of the issue. Answer these next three questions to see how these rules are important:

• Do you set your fees based on the time involved in providing services?
• Do you have a fee plan for offering Telehealth Services within your practice?
• Do you have a fee plan for handling multiple procedures?

It’s not enough in today’s world to just raise your fees by the predicted amount of inflation or by choosing a dollar amount. We need to become more sophisticated in this process. Answering the above three questions will set you on the path to improved thinking about setting your fees for the next fiscal year.

Take this month gather the necessary information to set your fees for next year.

 

References
i. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/
ii. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1715-F.html
iii. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1715-F.html

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