On July 8, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning January 1, 2014. CMS proposes to update the OPPS market basket by 1.8 percent for CY 2014. The proposed hospital market basket increase published in the Fiscal Year (FY) 2014 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule is 2.5 percent. The Medicare statute requires a productivity adjustment reduction of 0.4 percentage points and a 0.3 percentage point reduction to the CY 2014 OPPS market basket. Total calendar year (CY) 2014 OPPS payments are projected to increase by $4.37 billion or 9.5 percent, and CY 2014 Medicare payments to ASCs are projected to increase by approximately $133 million or 3.51 percent as compared to CY 2013.
The CY 2014 Outpatient Prospective Payment System (OPPS)/ASC rule proposes to expand the categories of related items and services packaged into a single payment for a primary service under the OPPS, in order to make the OPPS more of a prospective payment system. The proposed rule would further expand the categories of packaged items and services by adding seven additional categories of supporting services. In addition to packaging these seven categories, CMS is proposing to create 29 comprehensive ambulatory payment categories (APCs) to replace 29 existing device-dependent APCs.
ASC payments are annually updated for inflation by the percentage increase in the consumer price index for all urban consumers (CPI-U). For CY 2014, the CPI-U update is projected to be 1.4 percent. The multifactor productivity (MFP) adjustment is projected to be 0.5 percent, resulting in an MFP-adjusted CPI-U update of 0.9 percent for CY 2014. In addition, CMS is proposing that certain ancillary or adjunctive services that would be packaged under the OPPS for CY 2014 also would be packaged under the ASC payment system for CY 2014. Payments to ASCs that fail to meet ASC Quality Reporting Program requirements would be reduced by two percent.
CMS will accept comments until September 6 and the final rule is expected to be released by November 1, 2013.
The proposed rule can be accessed at: