Reimbursement

Philips cautions on Medicare outpatient cuts

September 29, 2018

 

Philips Cautions on Medicare Outpatient Cuts

 

Philips Healthcare is cautioning the Centers for Medicare & Medicaid Services (CMS) that the agency’s recent proposal for updating payment rates and policies for hospital outpatient department care in Calendar Year 2019 threatens to reduce patient access to necessary medical imaging services.  Philips made the warning in formal comments to CMS, which is expected to release its final policies in November 2018.

 

Highlights of Phillips Comments:

 

  • Imaging APCs:  Philips opposed payment reductions that CMS proposed in contrast-enhanced imaging procedures, saying that reductions of this magnitude had the potential to harm patient access to critical services.  It asked the agency to closely examine imaging APCs to ensure payment is adequate to cover the costs involved.

 

  • Off-Campus Clinics:  Philips recommended that CMS refrain from implementing its proposed 60% payment reductions for clinic visits to off-campus provider-based facilities that had previously been exempt from such deep payment reductions.  Philips also urged CMS to refrain from extending similar payment reductions to other outpatient services offered in such facilities, including medical imaging.

 

  • Endovascular APCs:  Philips suggested that CMS add additional levels of ambulatory payment classifications (APCs) within the endovascular APC family to help reduce the current underpayment or overpayment in the group.  It pointed out that under the current APC structure, peripheral angioplasty and peripheral stenting revascularization are significantly underpaid.  To address the issue, the company suggested six levels of APCs to replace the existing four levels. Philips also recommended new codes to distinguish peripheral interventions involving drug-coated and drug-eluting technologies.