Reimbursement


Philips Comments on Medicare Payment Proposals

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October 3, 2019

Philips Comments on Medicare Payment Proposals

As the Centers for Medicare & Medicaid Services (CMS) moves toward finalizing hospital outpatient and physician payment rates for 2020, Philips Healthcare has expressed its support for measures that would expand patient access to telehealth, remote patient monitoring, and breakthrough devices. Philips also recommended adjustments in the CMS proposals that would lead to more appropriate pricing for imaging products and procedures.

Philips made the comments in response to CMS proposals for updating payment rates and policies for the 2020 physician fee schedule and the hospital outpatient department payment system, as well as payment for ambulatory surgical centers. CMS is expected to finalize its proposals in November 2019, with the changes taking effect January 1, 2020.

Highlights:

Innovative Technologies:
Philips supported CMS proposals to allow pass-through payment under the hospital outpatient payment system for FDA-cleared “breakthrough technologies” without requiring that such technologies demonstrate “substantial clinical improvement.”

Telehealth: Philips applauded CMS for its efforts to expand access to telehealth and remote patient monitoring. These efforts include agency proposals to cover telehealth for use in care management and counseling for opioid treatment programs.

Procedures Performed in ASCs: Philips said it agreed with the CMS proposal to add three coronary intervention procedures to the list of services the agency will cover in ambulatory surgical centers.

Payment Adjustments: Philips pointed out areas where payment policies should be adjusted to reflect true resource use or more appropriate pricing. These included:
  • In the hospital outpatient system: cost-to-charge ratios for MRI and CT; payment for imaging guidance for non-opioid drugs; and classification of prostate high-intensity focused ultrasound into a different ambulatory payment classification (APC).
  • In the physician fee schedule: pricing for intravascular ultrasound, remote patient monitoring, and radiopharmaceutical tumor localization SPECT and SPECT-CT; as well as equipment cost inputs for complete joint ultrasound.