Preparing for 2020 SNF Billing & Part B Payment Changes
Skilled nursing facilities (SNF) are starting the new year with multiple changes that will affect Medicare billing.
The physician fee schedule changes annually, which affects payment for therapy services under Medicare Part B. The rates effective for services during calendar-year 2020 are currently unavailable due to recent legislation, but once they’re available, they can be downloaded from our website. This is due to President Trump signing the Further Consolidated Appropriations Act, 2020 on December 20, 2019, which will extend the geographic practice cost index (GPCI) floor that was set to expire December 31, 2019. Billing systems will need to be updated to reflect the updated Part B rates prior to billing January services.
The Part B KX modifier threshold (previously called the therapy cap) increased to $2,080 for 2020. As in prior years, the threshold calculation is combined for both physical therapy (PT) and speech-language pathology (SLP) services, while occupational therapy (OT) services are calculated separately. Once the threshold is exceeded, services must be billed with modifier KX or they’ll be rejected. Modifier KX confirms services were medically necessary and supported by medical documentation. The Part B threshold for targeted medical review remains at $3,000 for 2020, once again with OT being separate and SLP and PT being combined.
A new change for 2020 is the requirement to bill a modifier for PT and OT services performed in whole or in part (10 percent or more) by a PT assistant or OT assistant. The new modifiers are CQ for PT and CO for OT. Billing and therapy staff should work together to determine how to track these modifiers. Billing staff also should work with their software vendor to determine if additional charge codes will need to be set up to reflect the new modifiers or if charge imports containing the new modifiers will automatically flow through to claims. Effective January 2022, these services will be reduced by 15 percent of the fee schedule amount.
The SNF Medicare Part A coinsurance rate for 2020 is $176.
Finally, the new Medicare Beneficiary Identifier (MBI) requirement is effective for all claims billed January 1, 2020, regardless of service dates. Staff responsible for transmitting minimum data set assessments also should ensure they’re using the MBI for all submissions beginning January 1, 2020.
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