CMS Proposes Payment Policies and Rates for 2013

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  • July 13, 2012
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In rapid fire succession, the Centers for Medicare & Medicaid Services (CMS) released proposed rules in July that will dictate payment policies and reimbursement rates for health care providers in 2013 in several programs: medicare physicians fee schedule (MPFS), outpatient prospective payment system (OPPS), home health, skilled nursing facilities (SNF), and end stage renal disease (ESRD).
In the 2013 MPFS proposed rule, CMS takes the stance that the scheduled reduction of 27 percent in MPFS pay rates under the sustainable growth rate (SGR) methodology won’t happen because Congress will step in to override the SGR just as it has since 2003.  Comments are due September 4 for the rules, which will be published in the Federal Register July 30.
With that off their plate, the agency focuses on other matters, such as the proposal to create a new procedure code to reimburse physicians and other practitioners for assisting a patient’s transition back to the community following a hospital or SNF discharge. CMS estimates this provision would increase payments to family physicians by approximately 7 percent, and payment to other practitioners providing primary care services between 3 and 5 percent.
See the AAPC News articles “MPFS: 2013 Changes to Physician Quality Programs”,  “MPFS: Value Modifier Would Affect Payment”, and “CMS MPFS Proposed Rule  Solves PRoblems , Flexes Muscles” in this issue of EdgeBlast for more MPFS proposed rule provisions.

Outpatient Prospective Payment System and Ambulatory Surgical Centers

In the 2013 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) proposed rule, CMS is proposing to increase OPPS pay rates by 2.1 percent and ASC pay rates by 1.3 percent.
Also in the proposed rule, CMS would pay for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals without pass-through status at the statutory default of average sales price (ASP) plus 6.0 percent.
Home Health Prospective Payment System
In the 2013 Home Health Prospective Payment System (HH PPS) proposed rule, CMS proposes to reduce Medicare payments to home health agencies (HHAs) in 2013 by 0.1 percent.
Also in this proposed rule, CMS proposes requirements for the Hospice Quality Data Reporting Program and sets out to establish requirements for unannounced, standard, and extended surveys of HHAs and provide a number of alternative (or intermediate) sanctions that could be imposed on non-compliant HHAs.

End-stage Renal Disease Prospective Payment System

CMS also issued a proposed rule July 2 that would update payment policies and rates paid under the End-stage Renal Disease Prospective Payment System (ESRD PPS) in 2013.
Proposed changes include a 2.5 percent update to the ESRD PPS base rate of $240.88, or a composite base rate of $145.49 for facilities that are in the transition period.
CMS also proposes to update requirements for the Quality Incentive Program (QIP), including the measures and scoring methodologies that would affect payments to dialysis facilities in 2015.
These proposed rules will appear in the July 30 Federal Register. CMS will accept comments on the proposed rules until Sept. 4, and will respond to comments in the final rules, to be issued by Nov. 1.

Ambulatory Surgical Center CASCC

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  1. Diane Benson says:

    What is a non-compliant home health agency?