CMS rule would increase outpatient, ambulatory payments

The Centers for Medicare & Medicaid Services on Monday proposed increasing hospital outpatient payment rates by 1.8 percent for calendar year 2014.

Under the Hospital Outpatient Prospective Payment System (OPPS) proposed rule, about 4,000 hospitals would see $50.4 billion next year, $4.4 billion more than OPPS payments in 2013. Hospitals that miss hospital outpatient quality reporting requirements would see their payments drop by a statutory two percentage points.

The rule also proposes a 0.9 increase in ambulatory surgical center (ASC) payments. That would give about 5,000 ASCs $3.980 billion next calendar year, up $133 million from ASC payments in 2013.

To improve transparency, CMS also proposed to replace the five levels of outpatient visit codes with a single code for each type of outpatient hospital visit as well as create 29 comprehensive ambulatory payment classification groups (APC) instead of the existing device-dependent APCs.

"We believe that defining certain services within the OPPS in terms of a single comprehensive service delivered to the beneficiary improves transparency for the beneficiary, for physicians, and for hospitals by creating a common reference point with a similar meaning for all three groups and  using the comprehensive service concept that  already identifies these same services when  they are performed in an inpatient environment," the rule states.

CMS will finalize the 2014 OPPS and ASC payment rates at least 60 days before Jan. 1, 2014, according to guidance from the Office of Information and Regulatory Affairs (OIRA). But the guidance notes that if the CMS regulation is not published in time, hospital outpatient departments and ASCs will recieve incorrect payments next year.

For more:
- here's the proposed rule (.pdf)
- read the OIRA guidance