CMS 2020 Final Rules for Quality Reporting

November 29, 2019

Understanding how quality reporting will change in 2020 and beyond

Hospitals, surgery centers and clinicians report to different Medicare programs on their quality performance to receive reimbursements for procedures performed. CMS has released multiple changes to Medicare Quality Reporting Programs for 2020 for the gastroenterology (GI) specialty.

Reporting on performance measures helps facilities ensure quality procedure outcomes, so it’s important for sites to recognize and implement changes for 2020.

Changes in GI-specific requirements

The following quality reporting programs have changes that will begin in 2020.

1. Merit-Based Incentive Payment System (MIPS)

There are two quality payment program options available for clinicians to receive reimbursement under Medicare Part B: MIPS and APMs (Advanced Alternative Payments Models). The goal of both programs is to give healthcare providers incentives to improve patient care and service quality, while keeping costs under control. Currently, the majority of eligible clinicians participate in MIPS.

Starting in 2020, CMS final rules state that two measures will be removed from the MIPS GI quality measure set:

  • Inflammatory Bowel Disease: Corticosteroid Related Iatrogenic Injury – Bone Loss Assessment
  • Screening Colonoscopy Adenoma Detection Rate (ADR)

See why removing Screening Colonoscopy ADR is concerning.

2. Ambulatory Surgical Center Quality Reporting (ASCQR)

ASC facilities must report to ASCQR to receive the full annual update to their ASC annual payment rate.

In 2020, two measures will be added to the ASC quality reporting program:

  • Hospital Visits after Orthopedic ASC Procedures
  • Hospital Visits after Urology ASC Procedures

Both of these additions reflect the focus of quality of physician performance at ASCs.

3. Hospital Outpatient Quality Reporting Program (Hospital OQRP)

The Hospital OQRP is a quality data reporting program for outpatient hospital services. Outpatient facilities must report to the Hospital OQRP to avoid a 2% point reduction in payment.

In 2020, one measure will be dropped from the HOQRP quality reporting program:

  • External Beam Radiotherapy for Bone Metastases

GI-focused hospitals and ASCs, as well as gastroenterologists, must consider CMS changes in quality reporting this year. For more information on a solutions that ensure your facility is reporting accurately and efficiently to quality reporting programs, visit Provation Physician Documentation.


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