By Kate Madden Yee, staff writer

July 8, 2009 -- The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed a 1.9% increase in payments to hospitals and ambulatory surgery centers in an update of rates in its Hospital Outpatient Prospective Payment System (HOPPS).

HOPPS is the agency's prospective payment system that uses median costs based on claims data to set the relative payment weights for hospital outpatient services.

CMS has proposed increasing the 2009 conversion factor of $66.06 by 2.1% and a 0.01% adjustment of projected OPPS spending, resulting in a conversion factor of $67.44 for 2010.

The agency has also suggested quality measures for its Hospital Outpatient Quality Data Reporting Program for reporting this data for annual payment rate updates for 2011 and subsequent years. Hospitals that fail to meet the reporting requirements of this program will sustain a 2% reduction of the conversion factor, the rule proposes.

Ambulatory payment classifications

The agency is not suggesting any new composite ambulatory payment classification (APC) groups for 2010 in order to monitor the effects of the existing composite APCs on utilization and payment, according to the American College of Radiology (ACR) in Reston, VA. Composite APCs provide a single APC payment when two or more imaging procedures using the same imaging modality are provided in a single session.

CMS established five imaging composite APCs in 2009: ultrasound; CT and CT angiography with and without contrast; and MRI and MR angiography with and without contrast.

Packaging of radiation therapy guidance services

In addition, the agency is not proposing to pay separately for radiation therapy guidance services provided in the treatment room in 2010. CMS plans to maintain the packaged status of radiation therapy guidance services, according to the proposed rule.

Physician supervision

Finally, CMS is proposing a requirement that all hospital outpatient diagnostic services, provided directly or under arrangement -- whether in the hospital, in a provider-based department, or at a nonhospital location -- follow the Medicare Physician Fee Schedule (MPFS) physician supervision requirements for individual tests, the agency wrote.

CMS will take comments until August 31, 2009. A final payment rule will be issued November 1.

By Kate Madden Yee staff writer
July 8, 2009

CMS pitches 90% use rate in proposed 2010 MPFS rule, July 1, 2009

CMS to raise hospital outpatient payments 3%, July 8, 2008

CMS delays Medicare payments due to SGR impasse, July 1, 2008

Beware, AMIC says: The DRA could be the least of it, June 10, 2008

ACR update: Teaching Congress how to fish, May 7, 2008

Copyright © 2009


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