Final Rules Update 2013 Medicare Payments For ESRD, Home Health, Outpatient Hospital, and Physician Services

from Spencer’s Benefits Reports: The Centers for Medicare and Medicaid Services (CMS) recently issued four final rules that pertain to the Medicare program. Proposed rules were issued in July. All four rules are generally effective beginning Jan. 1, 2013.

ESRD PPS. The CMS issued a final rule that updates and revises the end-stage renal disease (ESRD) prospective payment system (PPS) for 2013. This rule also sets forth requirements for the ESRD quality incentive program, including for 2015 and beyond. In addition, it implements changes to bad debt reimbursement for all Medicare providers, suppliers, and other entities eligible to receive Medicare payment for bad debt and removes the cap on bad debt reimbursement to ESRD facilities. This final rule was published in the November 9 Federal Register.

HH PPS. A final rule has been issued that updates the Home Health (HH) PPS rates, including the national standardized 60-day episode rates, the national per-visit rates, the low-utilization payment amount, the non-routine medical supplies conversion factor, and outlier payments under the Medicare prospective payment system for home health agencies. This rule was published in the November 8 Federal Register.

Hospital OPPS. The CMS has revised the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for 2013. In this final rule, the CMS has described the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. The final rule was published in the November 15 Federal Register.

In addition, the final rule updates and refines the requirements for the Hospital Outpatient Quality Reporting program, the ASC Quality Reporting program, and the Inpatient Rehabilitation Facility Quality Reporting program. In addition, the CMS notes that it is continuing the electronic reporting pilot for the Electronic Health Record Incentive program, and revising the various regulations governing Quality Improvement Organizations, including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes.

Physician Fee Schedule. Finally, the CMS issued a final rule with comment period that addresses changes to the physician fee schedule, payments for Part B drugs, and other Medicare Part B payment policies to ensure that the payment systems are updated to reflect changes in medical practice and the relative value of services. It also implements provisions of the Patient Protection and Affordable Care Act by establishing a face-to-face encounter as a condition of payment for certain durable medical equipment items. In addition, it implements statutory changes regarding the termination of non-random prepayment review. This final rule is scheduled to be published in the November 16 Federal Register.

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