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June 20, 2014

Some outpatient hospital services will now receive better services from medicare in 2014

New proposed rules for the hospital outpatient prospective system (OPPS), released earlier this week by The Centers for Medicare & Medicaid Services’ (CMS) 2014, offering payment upsurges and “packaging” of services.

The recommended rule would increase hospital OPPS payments by $4.37 billion or 9.5 percent, and 2014 Medicare payments to ambulatory surgical centers (ASCs) by approximately $133 million or 3.51 percent, as compared to 2013, according to a CMS press release.

A dispersed payment would still be made if an item included in a bundle is reported alone on a claim. In its effort to continue streamlining the payment system, CMS proposes to “package” particular services and supports into seven new categories.

CMS also proposes collapsing the current five levels of outpatient visit codes to one. CMS believes this option “… will remove incentives hospitals may have to provide medically unnecessary services or expend additional, unnecessary resources to achieve a higher level of visit payment under the OPPS, will reduce administrative burden and be easily adopted by hospitals, and will allow a large universe of claims to be utilized for rate setting,” the agency said in its press release.

Ending the undeviating supervision enforcement delay for critical access hospitals and small rural hospitals Dec. 31 was also proposed in the rule and creating 29 wide-ranging ambulatory payment taxonomies to replace existing device-dependent APCs.

Comments are due to CMS by Sept. 6 and final rules are expected by Nov. 1, according to the press release. The proposed rule is scheduled to appear in the Federal Register on July 19.

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