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CMS finalizes rates for hospitals’ off-campus sites


CMS has finalized the new payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center Payment System (ASC).

Altogether, the changes would boost the OPPS payments  1.7 percent and ASC payments  1.9 percent in 2017.

But hospitals will not win  everywhere.  For example, the new OPPS rules exclude payments of certain outpatient services at inpatient levels at  hospitals’ off-site facilities.

CMS said: “This payment differential has provided an incentive for hospitals to acquire physician offices in order to receive the higher rates. This acquisition trend and difference in payment has been highlighted as a long-standing issue of concern by Congress, the Medicare Payment Advisory Commission, and the Department of Health and Human Services Office of Inspector General.”

“We spoke to stakeholders across the outpatient community who care about the quality and value of care that Medicare patients receive,” said Sean Cavanaugh, CMS deputy administrator. “The policies finalized in today’s rule will not only improve the value of care provided to Medicare beneficiaries, but are also responsive to healthcare providers who are crucial to outpatient care.”

Physician groups have mostly supported “site-neutral payments” but many hospital leaders have strenuously opposed them for fear of losing money.   The Bipartisan Budget Act passed by Congress last year essentially eliminated the payment disparities between different sites.

CMS also issued an interim final rule on the Medicare Physician Fee Schedule  to  address other payments received by off-campus hospital providers.

To read a FierceHealthcare article on this, please hit this link.

Maximizing provider reimbursement under MACRA

Here’s some guidance on finding the best way to maximize provider reimbursement under the Medicare Access and CHIP Reauthorization Act (MACRA),  signed into law last year.

The law  is designed, among other things, to restructure how reimbursement rates are calculated for individual doctors in the Medicare Physician Fee Schedule.

MACRA  repealed the flawed Sustainable Growth Rate formula for  Medicare payments for clinicians’ services, and established  a new framework for rewarding physicians based on “value” rather than volume.

Modern Medicine noted that “By comparing physician compliance against national averages with mandated regulations across many specifically defined quality metrics and measures, CMS hopes to reduce what it considers costly medical redundancies and improve overall patient health and safety.”

According to the legislation, all eligible providers, “including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists… shall receive annual payment increases or decreases based on their performance as measured by standards the Secretary [of Health and Human Services] shall establish according to specified criteria” from 2019 on.

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