|
Hello,
CMS releases
payment rates and policies for hospital outpatient services and ASCs
The
Centers for Medicare & Medicaid Services (CMS) released a proposed rule
outlining 2010 payment rates under the Hospital Outpatient Prospective
Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment
System. The proposed rule also includes 2010 payment policies under both
payment systems.
OPPS
proposals
CMS
predicts that entities paid under the OPPS system will receive a 1.9
percent increase in their payments for 2010. Of note, the agency included a
number of policy changes relating to physician supervision requirements. It
proposes to allow nonphysician practitioners (NPPs) to directly supervise
hospital outpatient therapeutic services if NPPs are allowed to personally
perform them under state scope-of-practice requirements and when
granted privileges by the hospital. NPPs included in this proposal are
physician assistants, nurse practitioners, certified nurse specialists and
certified nurse-midwives.
In
addition, CMS is proposing to refine the definition of direct supervision
for both therapeutic and diagnostic services furnished in an on-campus
outpatient hospital facility, as well as in off-campus, provider-based
departments. For on-campus facilities, the definition would require the
physician to be present on the same campus, in the hospital or the
on-campus provider-based department of the hospital. The physician must be
immediately available to furnish assistance and direction throughout the
performance of the procedure. For off-campus services, direct supervision
will continue to require that the physician must be present in the
off-campus, provider-based department of the hospital and immediately
available to furnish assistance and direction throughout the performance of
the procedure. This does not mean that the physician must be present in the
room when the procedure is performed. Additionally, the proposal specifies
that all hospital outpatient diagnostic tests must comply with the
supervision requirements set forth in the Medicare physician fee schedule.
ASC
proposals
CMS is
gradually moving payment rates for ambulatory surgery centers (ASCs) to a
new payment system; 2010 marks the third year of a four-year transition. As
a result, 25 percent of payment for services in 2010 will be based on the
previous Medicare payment system and 75 percent on the new system that
links payment for services to payments received under the OPPS. In
addition, 2010 is the first year that ASCs are eligible for inflationary adjustments:
They could see a 0.6 percent increase in their conversion factor. CMS also
proposes to add 28 surgical procedures to the list of services that can be
performed in ASCs and 6 procedures to the list of office-based procedures.
The agency declined to include a requirement that ASCs engage in quality
reporting, deferring that requirement for a future rulemaking.
MGMA
will continue to analyze the provisions in this rule to assess their impact
on MGMA members. Comments on the rule are due to the agency by Aug. 31.
Read the
CMS
press release.
Read the
CMS
fact sheet.
CMS
corrects National Correct Coding Initiative files
The
Centers for Medicare & Medicaid Services (CMS) acknowledged that it
posted faulty National Correct Coding Initiative files for physicians for
the July 1-Sept. 30, 2009 period to its Web site. CMS asks
providers to download the corrected
version. You can also download a related educational article.
|
.jpg)
