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Rule hikes payment rates for outpatient, ASC services


By Maureen McKinney
Posted: November 1, 2012 - 6:30 pm ET
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The CMS has issued a final payment rule (PDF) for hospital outpatient and ambulatory surgery center services, upping hospital payment rates by 1.8% and increasing payments to ASCs by 0.6% in the upcoming year.

The agency estimated that payments for hospitals under the Outpatient Prospective Payment System will total roughly $48.1 billion in 2013. Payments to ambulatory surgery centers will be approximately $4.07 billion, according to the CMS.

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The rule bases relative payment weights on geometric mean costs rather than median costs. The agency said doing so would better reflect the average costs of services and align the payment methodology with the inpatient prospective payment system.

Also included in the rule were several changes to the federal government's outpatient quality reporting program, which will base a portion of hospitals' payments on their reporting of a set of quality measures. The CMS removed one measure, suspended data collection for another, and deferred data collection for a third, leaving a list of 22 for 2014's payment determination.

In addition, the rule added new requirements for quality improvement organizations, contracted entities that work with the CMS to improve Medicare quality.

“For example, the rule requires QIOs to provide beneficiaries with more information about their review processes,” the CMS said in a fact sheet. “It establishes a new alternative dispute resolution option called “Immediate Advocacy” to resolve beneficiary complaints. It allows QIOs to send and receive secure electronic health information. Finally, the rule gives beneficiaries the right to authorize the QIOs' use and disclosure of confidential information and removes outdated regulations so that QIOs will have to provide beneficiaries with more information about specific reviews.”


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