Many Hospitals Concerned about Final CMS Payment Rules

The Centers for Medicare and Medicaid Services (CMS) announced a final rule for hospital outpatient services, or the Outpatient Prospective Payment System (OPPS), this November. The CMS estimates that the rule will increase payments for hospital outpatient departments by 1.7 percent. The new rule will be effective January 1, 2014; however, CMS will delay implementation and final configuration of the new 29 comprehensive APCs until 2015.

The rule will create 29 comprehensive Ambulatory Payment Classifications (APCs) to handle payment for device-dependent services and will require direct supervision for a range of outpatient services in critical access hospitals (CAHs). 

This rule combines five payment codes into a single payment code that covers all outpatient clinic visits. The outpatient clinic visits code will include drugs, biologicals, and radiopharmaceuticals used in a diagnostic test or surgical procedure, lab services and device removal procedures. The American Hospital Association believes that the payments will be well below the cost of treatment for complex patients.

The Access to Medical Imaging Coalition is concerned that the rule will dramatically reduce the outpatient payments to hospitals for CT scans and MRI services. The group is concerned because the rule will establish similar reimbursement rates for a CT scan and x-ray image of the same body part even though a CT scan requires more expensive equipment and is more expensive to adminster. 

Many hospitals are concerned about being able to implement the changes required by the rule by January 1, 2014, the date the rule becomes effective.