The federal government's delay in publishing the Medicare prospective payment system rules for outpatient departments may not give hospitals a reprieve from making some major changes to their billing systems.
HCFA has proposed changes to the way Medicare reimburses freestanding ambulatory surgical centers. Although Medicare pays hospital outpatient departments a different fee than ASCs for the same procedure, Medicare bases the hospital outpatient rates on the ASC rate.
HCFA proposes that beginning Oct. 1, it would expand the number of ASC procedural groups-each of which receives the same fee-from the current eight to 105 payment groups. Called ambulatory payment classifications, HCFA's new categories are similar but not identical to the ambulatory patient groups developed by 3M Health Care for private outpatient billing procedures.
The proposed rule said ambulatory patient classifications will probably be the basis for the hospital outpatient department PPS, which had been scheduled to take effect beginning Jan. 1, 1999. Congress set that deadline in the Balanced Budget Act in 1997.
HCFA's difficulties with readying its information systems for the year 2000 have caused it to delay the outpatient PPS until 2000 (June 29, p. 4), but it is pressing ahead with the ASC billing changes.
Hospitals are objecting to the timing of HCFA's proposed changes in ASC payment. That's because hospitals would be forced to change their outpatient billing systems twice-once to incorporate the pending ASC changes and again to incorporate the PPS. Hospitals argue they would have to make these changes while preparing their own data systems for the year 2000. So they want the ASC changes delayed until the outpatient PPS is implemented.
"This appears grossly unfair," the American Hospital Association wrote in a comment letter. "It is inconsistent of HCFA to delay its changes while expecting us to change our systems."
"System changes are expensive, they're time-consuming, and they deflect our resources," said Linda Magno, AHA's interim vice president for policy.
Comments on the proposed ASC payment changes are due by Sept. 10.