The 2020 IPPS Proposed Rule was put on display for public inspection on April 23, 2019, and subsequently published in the Federal Register May 3, 2019. You can view the rule in its entirety here. If finalized, the proposed 2020 IPPS rule will affect discharges on or after October 1, 2019. Each year, CMS publishes updates to the regulations for inflation factors, wage adjustments, etc. The rates that are reviewed in this post are the non-wage index adjusted rates for specific Core-Based Statistical Areas (CBSAs) as well as other updates made to the standardized rates.
It is recommended that hospitals load the rates listed below along with other factors such as DSH, Wage Index, IME, etc., into their patient accounting system that is used to bill Medicare (i.e. EPIC, etc.). For the non-wage index adjusted rates for specific CBSAs located in Tables 1A and 1B below, hospitals will need to determine which category their facility falls into and load those corresponding rates.
Once the 2020 rates are incorporated into the hospital's billing system, it is a best practice to validate the rates are calculating accurately. We recommend pulling a paid claim and running it through the pricer for IPPS which can be downloaded from the CMS website.
The tables that follow include the proposed CMS 2020 updated rates along with the calculation change from the 2019 rates:
In addition to the rates above, there are a couple of other notable items from our review of the IPPS proposed rule related to rates:
CMS is soliciting comments on how the wage index is calculated. Over time, there has been a growing disparity between the rural and urban wage index where CMS would like to minimize the gap.
CMS is updating the quality program for IPPS.
Additional rate updates include:
Public Comments for the 2020 IPPS proposed rule can be submitted through 5pm EST on June 24, 2019. CMS has also released the 2020 IPPS, Rehab, Psych and SNF proposed rules. Be sure to review the posts for highlights and be sure not to miss future posts about these rules by to subscribing to our blog below:
Additionally, SCA is putting together our annual proposed rule webinar happening later in May. If you have not already, please register by clicking the link below.