Medical Billing Service Companies

CMS Updates For HOPPS

CMS published the Medicare Physician Fee Schedule Proposed Rule (NPRM) for reviews and comments in July. With that, CMS is looking to propose changes to the reimbursement rates for the services that come under the Physician Fee Schedule (PFS) and other similar payment policy.

CMS said that over a million medical suppliers, physicians, and practitioners, receive Medicare payment under the PFS. In order to calculate the reimbursement rates for Medicare Part B services, each medical service is assigned a Relative Value Units (RVU), which is then multiplied with a Conversion Factor (CF) to determine the final value.

RVU has three components: practice expense, physician work, and malpractice. The Relative Value Unit Committee or RUC (a committee run by the American Medical Association) recommends CMS on the matter, but the final decision will be of CMS.

The MACRA program applies a 0.5 percent update to the CF in 2017, which is contradicted by other payment adjustments authorized by Congress. Thus, the actual CF will decline by -0.08 percent. Several other proposals, for instance, the one-year delay for an ordering professional to consult a Qualified Clinical Decision Support Mechanism (CDSM) for advanced diagnostic imaging (computed tomography, diagnostic magnetic resonance imaging, and nuclear medicine), will also be revised by the 2017 PFS.

Medical Billing Consultants

Updates For MPFS

The new proposals by CMS more emphasized on primary care and management. The proposed changes include expanding the testing phase of Diabetes Prevention Program to the full Medicare program and new approach to cover behavioral health by a collaborative care coordination system.

Hospital Outpatient Prospective Payment System

CMS also released the Hospital Outpatient Prospective Payment System (HOPPS) proposed rule for 2017. HOPPS proposes annual updates to Ambulatory Surgical Center (ASC) and Hospital Outpatient Department (HOPD) payment policies. The agency proposed an update in payments by 1.2 percent for ASC and by 1.6 percent for HOPD.

The HOPPS proposed rule implements a site-neutral payment policy for “new” off-campus HOPDs – a facility that started presenting Medicare claims on or after November 2, 2015. However, Congress is trying to also include those facilities that were under construction at the time of passing site-neutral policy. As services billed under the HOPPS plan are usually reimbursed higher than that under the MPFS policy, the site-neutral payment policy aims to decrease the trend of hospitals overtaking physician offices.