Archive for Centers for Medicare & Medicaid Services

 

Medicare Announces FY 2019 Inpatient Payments

The Centers for Medicare & Medicaid Services has released its FY 2019 payment schedule for Medicare inpatient services.

Highlights of the FY 2019 inpatient prospective payment system regulation include:

  • A 1.75 percent increase in fee-for-service rates.
  • A $1.5 billion increase in Medicare disproportionate share hospital payments (Medicare DSH).
  • Major reductions of the quality measures hospitals must report for Medicare’s inpatient quality reporting and value-based purchasing programs.
  • A requirement that hospitals post their standard charges on the internet.

Learn about these and other aspects of Medicare’s FY 2019 inpatient prospective payment system regulation by seeing this Medicare fact sheet or going here to see the 2593-page (!) regulation itself.…

New Reg Pushes Medicare Toward Site-Neutral Outpatient Payments

Medicare would make more payments for outpatient services on a site-neutral basis under a newly proposed regulation just released by the Centers for Medicare & Medicaid Services.

The 2019 Medicare outpatient prospective payment system regulation, published in proposal form, calls for:

  • paying physician fee schedule rates rather than hospital outpatient rates at excepted off-campus provider-based departments;
  • slashing payments for office visits;
  • extending this year’s 340B prescription drug discount payments, already cut nearly 30 percent this year, to additional providers; and
  • raising ambulatory surgical center rates and expanding the list of procedures that can be performed in such facilities so they can compete with hospitals for outpatient services.

The proposed regulation also calls for reducing quality reporting requirements and giving providers financial incentives to prescribe non-opioid pain medicine for surgery patients.

The regulation, which would affect provider payments beginning on January 1, 2019, was published in proposed form and will be finalized later in the year.  Stakeholders have until September 24 to submit comments to CMS.  For further information about what CMS has proposed, see this CMS fact sheet outlining the proposed regulation and the 761-page proposed regulation itself.…

Proposal Would Equalize Medicare Physician Payments

All physicians would be paid equally for Medicare-covered office visits under a new proposal published recently by the Centers for Medicare & Medicaid Services.

Under the proposed regulation, Medicare would collapse four levels of patient evaluation and management office visits, eliminate the extensive documentation required to justify the payments physicians seek, and pay one simple rate for office visits.

CMS estimates that reducing the documentation requirements would save every doctor 51 hours a year.

Some critics are concerned that specialists and those caring for especially ill or especially complex patients would be shortchanged by the proposed policy while others fear that the resulting reduction of payment for some physicians might lead them to reduce the number of Medicare patients they are willing to treat, thereby potentially reducing access to care for some Medicare patients.

Currently, Medicare payments for established patients range from $45 to $148, depending on the nature of the office visit.  Under the CMS proposal, physicians would receive a uniform rate for Medicare-covered office visits:  $93.

The proposed policy is budget-neutral.

Learn more about Medicare’s proposed changes in physician reimbursement in this New York Times article.  Go here to see a fact sheet on the proposed Medicare …

CMS Proposes Changes in Medicare Physician Payments

The Centers for Medicare & Medicaid Services has published a proposed regulation that it says

…proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. The proposed rules would fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information instead of information that is only for billing purposes.

Among the policy changes offered in the proposed 1743-page regulation governing Medicare physician payments are:

  • a 0.25 percent increase in physician fees;
  • changes in how physicians and other clinicians document and bill for their services;
  • new provisions governing Medicare payments for telehealth services, including those offered by phone;
  • reductions in the cost of new prescription drugs and reduced payments to physicians for administering drugs;
  • changes in the Medicare quality program;
  • the continuation of the current site-neutral payment policy for outpatient services; and
  • changes in the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) program.

Stakeholders have until September 10 to submit formal comments about the CMS proposals.

Learn more about these …

With Eye on Value-Based Care, CMS Eyes Stark Law Change

Interested in addressing legal obstacles that prevent providers from participating in innovative payment models, the Centers for Medicare & Medicaid Services has put out a call for stakeholders to address challenges raised by the so-called Stark law that makes it difficult for physicians to participate in such models.

In a news release accompanying CMS’s publication of its request for information, the agency notes that

Over the past year, CMS has engaged with the provider community in a discussion about regulatory burden issues. This included publishing a Request for Information (RFI) soliciting comments about areas of high regulatory burden. One of the top areas of burden identified in the over 2,600 comments received was compliance with the Stark Law and its accompanying regulations.

The news release also explains that

“We are looking for information and bold ideas on how to change the existing regulations to reduce provider burden and put patients in the driver’s seat,” said CMS Administrator Seema Verma. “Dealing with the burden of the physician self-referral law is one of our top priorities as we move towards a health care system that pays for value rather than volume.” 

In general, the Stark law prohibits physicians from referring patients to …