PBN’s 2020 predictions: Missed on health reform, hit on E/M changes and most else

Why This Topic Matters

It provides a concise retrospective on policy and reimbursement trends that affected physician practices, including Medicare payment changes, telehealth growth, and compliance risks. Readers can quickly assess whether the article is relevant to their interests in coding, billing operations, and federal health policy.

Article Sections

1. 2020 predictions

   An overview of the article’s year-end review format and the major policy areas examined across the 2020 prediction set.

2. Prediction: Except for small changes around the edges, federal health care reform will stall in 2020.

   Discussion of how the COVID-19 public health emergency and Medicare policy changes altered the expected trajectory of federal health reform and related administrative priorities.

3. Prediction: The 2021 E/M office visit documentation revisions will proceed as planned, but CMS will face adamant pushback on the payment side — and the proposed E/M rates will get chopped.

   Coverage of evaluation and management office visit documentation and payment developments, including CMS response and broader Medicare fee schedule effects.

4. Prediction: The increase in malware, ransomware and phishing attacks against health care facilities will continue substantially in 2020.

   A review of cybersecurity threats affecting health care organizations and the related operational and compliance concerns.

5. Prediction: Medicare for All will not be the Democratic rallying cry.

   A brief look at national political positioning on Medicare for All and how it factored into the 2020 election cycle.

6. Prediction: Obamacare’s biggest judicial challenge will fail in the Supreme Court.

   Coverage of major litigation involving the Affordable Care Act and its progression through the federal courts.

7. Prediction: Medicare Advantage will continue to grow — and so will enforcement threats based on faulty risk adjustment coding.

   Discussion of Medicare Advantage enrollment growth and compliance risk tied to risk adjustment and diagnosis reporting.

8. Prediction: Non-physician practitioner (NPP) utilization will rise in 2020.

   Trends in non-physician practitioner billing and utilization, with emphasis on physician assistant and nurse practitioner activity.

9. Prediction: Tech solutions will be used to ease the pain of prior authorization.

   A short update on prior authorization modernization efforts and related CMS rulemaking activity.

10. Prediction: Telehealth initiatives and participation will continue to soar in 2020.

    An overview of telehealth growth during the public health emergency and its impact on provider use and adoption.