What’s New for 2020?

on Monday, 06 January 2020. All News Items | Medicare Coverage | Documentation | Billing

Out with the Old, In with the New

“The secret of getting ahead is getting started. The secret of getting started is breaking your complex overwhelming tasks into small manageable tasks, and then starting on the first one.”
Mark Twain

In a related article in this week’s newsletter we looked back at Medicare changes impacting the Acute Care Hospital setting in 2019. This article serves as a reminder of new issues and opportunities in 2020.

January 1, 2020: Medicare Card Transition Has Ended: Claims to Reject

MLN Matters Article SE18006 was reissued on January 2, 2020 to update language showing the use of the new Medicare Beneficiary Identifier (MBI) has been fully implemented. The following reminders have been provided by Palmetto GBA in recent issues of their electronic Daily Newsletter:

Providers must use Medicare Beneficiary Identifiers (MBIs) for all transactions as of January 1, 2020. Palmetto GBA has updated eServices to accept only the MBI format for Medicare ID fields. If you do not use MBIs on claims (with a few exceptions) after January 1, regardless of the date of service, Medicare will reject the claim and you will get:

  • Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity’s contract/member number), and an Entity Code of IL (subscriber)
  • Paper claims notices: Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)” and Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”

How can you get the MBI? If your patients do not bring their Medicare cards with them:

For more information read the article posted on the CMS website 1/2/2020 at https://www.cms.gov/Medicare/New-Medicare-Card/index.

January 1, 2020: MLN Matters MM11574: Internet Only Manual Update to Pub 100.04, Chapter 16, Section 40.8 – Laboratory Date of Service Policy

Effective Date: January 1, 2020

Implementation Date: January 23, 2020

Information in this MLN article is intended for laboratories and other providers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed: CR 11574 updates the Laboratory Date of Service (DOS) Policy in Chapter 16, Section 40.8 of the Medicare Claims Processing Manual. Billing staff needs to be aware of the updates.

January 1, 2020:  BCBS of Alabama Blue Advantage Readmission Review Policy

BlueCross and Blue Shield (BCBS) of Alabama announced in November 2019 that starting January 1, 2020, they will flag and review all readmissions to the same facility within 30 days of discharge with some exclusions. The review is to determine if the readmission was preventable. If the stay could have been prevented, the claim will not be paid.

January 1, 2020: New Modifiers to Identify Occupational Therapy (OT) and Physical Therapy (PT) Services Provided by a Therapy Assistant

These new modifiers are mandated by the Balanced Budget Act (BBA) of 2018. The modifiers that are required to be reported on therapy line items when the services are furnished in whole or in part by a therapy assistant beginning in 2020 are:

  • CQ Modifier: Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant.
  • CO Modifier: Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant.

You can read more about this in a related MMP article at http://www.mmplusinc.com/news-articles/item/new-modifiers-for-therapy-assistant-services.

January 2020: Codes are Moving out of Local Coverage Determinations

The Local Coverage Determination (LCD) process was revised in response to the 21st Century Cures Act. One significant change is the relocation of codes (ICD-10-CM, CPT/HCPCS, Bill Type and Revenue) from LCDs and into local coverage Articles. Medicare Administrative Contractors were instructing to begin this process in January 2019 and is expected to continue through January 2020. Full alert can be found on the CMS Medicare Coverage Database at https://www.cms.gov/medicare-coverage-database/staticpages/notice-board-info.aspx.


March 2, 2020: 1st 2020 Palmetto GBA Medical Review (MR) Hot Topic Targeted Probe and Educate (TPE) Teleconference

Palmetto GBA hosts quarterly Medicare Review Hot Topic Targeted Probe and Educate (TPE) Teleconferences. Calls are open to all providers. During the calls Medical Review Subject Matter Experts will discuss and answer questions concerning the current TPE process.

Medical Review Hot Topic Targeted Probe and Educate Teleconference
Date March 2, 2020 June 1, 2020 September 8, 2020 December 7, 2020
Time 2:00 p.m. – 3:00 p.m. ET 2:00 p.m. -
3:00 p.m. ET
2:00 p.m. -
3:00 p.m. ET
2:00 p.m. -
3:00 p.m. ET
Participation Number (877) 789-3907 (877) 789-3907 (877) 789-3907 (877) 789-3907
Confirmation ID Number 9856007 9494605 9527339 3476497

This schedule is also available on the Palmetto GBA Event Registration Portal.


April 1, 2020: Implementation Date for New ICD-10-CM Diagnosis Code for Vaping-Related Disorder

April 1, 2020: New Important Message from Medicare (IM) and Detailed Notice of Discharge (DND): New Forms Required to Be Used

On January 8, 2020, CMS announced both forms have been updated. They note that “the IM has been revised and has a new CMS Form number (CMS-10065). It was formerly the CMS-R-193. Hospitals are required to use the new IM and DND beginning April 1, 2020. Both the previous and new versions of the notices are acceptable for use through March 31, 2020.” Notices are available at the following links:


Article by Beth Cobb

Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc.  Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. 

In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment (PAT) Tool. You may contact Beth at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information.  MMP, Inc. is not offering legal advice.  Every reasonable effort has been taken to ensure the information is accurate and useful.


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