At Healthcare Information Services, we strive to keep those in the healthcare industry informed about changes that could affect their practice. We’re always keeping an eye on updates from the Centers for Medicare & Medicaid Services (CMS). On July 10th of this year, they proposed a rule for Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System that would increase payments by 2.6%. The final rule on this proposal will occur in November after a 60-day comment period.
Here is everything you need to know about CMS’ proposal based on insights from Becker’s ASC Review.
Changes for Hospitals
The updated outpatient prospective payment system applies to hospitals that meet applicable quality reporting requirements. They have based this decision on a projected market basket increase of 3%. A 0.4% point productivity adjustment reduction was also taken into account. The existing rate structure for ASCs will remain in place – two intensive outpatient program ambulatory payment classifications (one for days with three services per day and one for days with 4+ services per day). Claims data from 2023 and current cost information will be used to set rates for 2025. Medicare payments for partial hospitalization program services in HOPDs would also be updated based on this new ruling.
Quality Reporting Program Guidelines
In order to support the ASC quality reporting program, CMS has proposed a Facility Commitment to Health Equity measure. This measure is set to include voluntary reporting on social determinants of health. CMS also plans to modify the immediate measure removal policy to an immediate measure suspension policy. Other reporting updates as part of this proposal include:
- CMS is considering revising data reporting requirements for ASCs. This update would ask ASCs to report data based on “quality measures that are generally applicable to all ASCQR Program individuals and relate to the conditions they treat or procedures they perform or can be abstracted from claims.” Comments and feedback on this change have been requested.
- Hospital outpatient quality reporting will be updated to exclude MRI lumbar spine measures for patients with low back pain. This decision was based on studies that found “performance or improvement on the measure did not result in better patient outcomes.”
Pushback from the Ambulatory Surgery Center Association
The ASCA CEO expressed disapproval of CMS’ omission of proposed code additions that had previously been submitted. He stated that Medicare beneficiaries would have more access to the care they need had CMS added 18 new cardiac and spine codes to the Covered Procedures List. The ASCA feels that a new, more transparent process should be accompanied by updates based on the clinical expertise of the surgeons who perform the affected procedures daily.
Orthopedic and Radiology Expertise and Support from HIS
We understand that changes and updates to the various processes throughout the medical industry can be confusing. At HIS, we proudly offer our practice management, revenue cycle, and medical coding expertise to orthopedic and radiology practices looking to optimize their financial operations while providing exemplary patient care. With over 30 years of experience in the healthcare industry, we are here to help you navigate your practice’s unique challenges and increase your profitability. To speak to one of our experts about all HIS can do for your practice, please contact us today!