On July 8, 2013,
the Centers for Medicare & Medicaid Services (“CMS”) released a proposed
rule that would update the payment policies and rates for services to Medicare
beneficiaries in hospital outpatient departments and ambulatory surgical
centers (“ASCs”) beginning January 1, 2014. CMS analyzed 2013 figures for the
more than 4,000 facilities paid under the Outpatient Prospective Payment System
(“OPPS”) and more than 5,000 Medicare-participating ASCs paid under the ASC
payment system, and obtained estimates of the benefits and impacts of the
proposed increases. The proposed rule would, among other aspects, increase
average OPPS Medicare payments by 1.8% and the Medicare payments to ASCs by 0.9%.
CMS further estimates that the increases to payment policies and rates of such
services will increase OPPS payments by $4.37 billion and the Medicare payments
to ASCs by $133 million.
If enacted, the
proposed rule would also expand the current categories of packaged services to
make the OPPS more of a prospective payment system and less of a
fee-for-service system. For the 2014 calendar year, the CMS is proposing to
package seven new items and services, which would be added to the list of those
already listed in 42 C.F.R. 419.2(b). Such items and services include:
·
Drugs,
biologicals, and radiopharmaceuticals that function as supplies in a diagnostic
test or procedure;
·
Drugs
and biologicals that function as supplies or devices in a surgical procedure;
·
Lab
tests;
·
Procedures
described by add-on codes;
·
Ancillary
services;
·
Diagnostic
tests on the bypass list; and
·
Devices
removal procedures.
CMS is also
proposing under this rule that certain ancillary or adjunctive items or
services would be packaged similarly under the ASC payment system for 2014.
Although the main
focus of the proposed rule is the increased OPPS and ASC Medicare payments, the
rule also discusses adding quality reporting measures for both OPPS and ASC.
Furthermore, the proposed rule discusses changes to conditions for coverage for
organ procurement organizations, revisions to the Quality Improvement
Organization regulations, changes to Medicare fee-for-service Electronic Health
Record Incentive Programs, and changes related to provide reimbursement
determinations and appeals.
CMS will accept
comments until 5:00 p.m. (EST) on September 6, 2013 on the proposed rule. The
proposed rule may be accessed here: http://www.ofr.gov/OFRUpload/OFRData/2013-16555_PI.pdf.
If you have
questions or would like more information about this proposed rule, its
implication, or other health care matters, please contact Susan Ziel at (317)
238-6244 or sziel@kdlegal.com.