Hospital groups generally are not pleased with the new CMS rule converting the current five-level, intensity-based payment system for clinic visits into a single outpatient visit code. But at least one hospital official isn't too worried.
Ken Fisher, chief financial officer of University of Iowa Hospitals and Clinics, said the Iowa City-based 692-bed hospital, which averages more than 800,000 outpatient visits a year, did its own assessment and found it would fare the same or even a little better financially under the flat payment rate.
“We're pretty ambivalent about it,” Fisher said. “It actually simplifies billing, which is a good thing, and it reduces the amount of back-end costs to get claims out the door.”
In its final outpatient prospective payment rule for 2014, released Nov. 27, the CMS said the change would incentivize hospitals to provide more efficient care for Medicare beneficiaries, reduce hospitals' administrative burdens and eliminate the temptation to upcode patients to higher-paying levels—a problem many experts say is widespread. Medicare payments for hospital outpatient services under the final rule will increase 1.7% in 2014. In addition, the agency finalized its proposal to no longer distinguish between new and established clinic patients.
“A single code and payment for clinic visits is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit,” according to a CMS news release.
Fisher acknowledged the potential for upcoding in a multilevel payment system for outpatient visits. “I don't disagree that is something (the CMS) should be concerned about,” he said.
But in a relief to hospital groups, the CMS announced it would not institute a Medicare flat-payment rate for emergency department visits, which it had proposed in July.