The FY 2020 Final IPPS Rule was issued by CMS on August 2, 2019 to update payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs). Some of the changes include:
- A major delay in the proposed changes to over 1,400 CC/MCC designations due to the overwhelming comments from the proposed rule
- Addition of drug resistance (Z16x) to the CC list
- Numerous MS-DRG changes including:
| Category | FY 2019 MS-DRG | FY 2020 MS-DRG |
| Allogeneic Bone Marrow Transplant | 014 | 016, 017 |
| Carotid Artery Stents | 034, 035, 036 | 037, 038, 039 |
| Diagnostic Imaging of Male Anatomy | 302, 303 | 729, 730 |
| Extracorporeal Shockwave Lithotripsy | 691, 692 | 693, 694 |
| Knee procedures with primary diagnosis of infection | 548, 549, 550 | 485, 486, 487 |
| Neuromuscular Scoliosis and Secondary Scoliosis/Kyphosis | 459, 460 | 456, 457, 458 |
| ICD-10-CM O99.89 – Other conditions affecting pregnancy, childbirth and the puerperium | 769, 776 | 817-819, 831-833 |
| Peripheral ECMO | 207, 291, 296, 870 | 003 |
| Pulmonary Embolism | 176 | 175 |
| Revision of Pacemaker Lead | 260, 261, 262 | 260, 261, 262 |
| Transcatheter Mitral Valve Repair with Implant | 216-221, 228, 229, 273, 274 | 266, 267, 319, 320 |
| Abnormal finding on diagnostic imaging of other specified body structures (R93.89) | 302, 303 | 947, 948 |
The Final Rule contains many additional detailed changes and revisions that involve quality reporting, new technology add-on payments, EHR incentives, and wage index disparities to name a few. We recommend you read the complete Final Rule to understand the changes and impact to your facility(ies). We also encourage you to provide staff education and implement system changes to ensure appropriate reimbursement and avoid denials.
Finally, although CMS has delayed the proposed CC/MCC designation changes for FY 2020, we highly recommend reviewing the proposed changes for IPPS FY 2021 and submitting comments to CMS. The proposed revisions, if adopted, will have significant financial impact to hospitals. All comments regarding the proposed changes must be submitted by November 1, 2019 to the CMS MS-DRG Classification Change Request Mailbox: MSDRGClassificationChange@cms.hhs.gov.
The official Federal Register document will be published on 8-16-19, however the unpublished pdf version can be downloaded now: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2020-IPPS-Final-Rule-Home-Page.html
CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2020-medicare-hospital-inpatient-prospective-payment-system-ipps-and-long-term-acute-0
