Reimbursement

2017 Medicare Payment for Outpatient, ASCs

July 8, 2016

 

Payments to hospital outpatient departments and ambulatory surgical centers treating Medicare patients will increase in 2017, but so will limits on how some of that money can be spent. The Centers for Medicare & Medicaid Services recently outlined its proposed payment rules and regulations for these facilities for calendar year 2017:

 

  • Payment Increase: CMS proposed an increase in spending of 1.6% for hospital outpatient departments and 1.2% for ambulatory surgical centers (ASCs).

 

  • Site Neutral Payments: Hospital outpatient departments that acquire off-campus physician practices will have to seek reimbursement under the less-lucrative physician fee schedule, not the outpatient payment system. The agency grants exceptions:
    • If the facility is within 250 yards of a hospital remote location.
    • If the facility is a dedicated emergency department.
    • If the care was billed before November 2, 2015.

CMS said that higher payments under the outpatient payment system have encouraged hospitals to acquire physician offices in order to receive the higher outpatient rates.

 

  • Appropriate Use: CMS is proposing that all medical practitioners who order advanced diagnostic imaging services must consult appropriate use criteria, and that imaging providers must report they have done so when filing claims for service under the physician fee schedule, the hospital outpatient payment system, and the ASC payment system.

 

  • Imaging APCs: The 17 current imaging APCs under the hospital outpatient payment system would be consolidated to 8 in 2017. CMS said the intent was to improve the clinical and resource homogeneity of the services classified within the imaging APCs.

 

  • Quality Reporting: CMS proposed a number of changes beginning in 2020, including adding quality reporting measures on admissions and emergency department visits for patients receiving outpatient chemotherapy and outpatient surgery.

 

Comments on the proposal are due September 6, 2016.

 

View CMS press release

 

View CMS fact sheet