United States

Federal Register, OPPS, physician fee schedule and quality reporting

INSIGHT ARTICLE  | 

Outpatient Prospective Payment System (OPPS), along with ambulatory surgical center and physician annual Federal Register updates, bring increasing significance and change to health care systems. Combine these updates with the reduction of inpatient admissions, increased financial incentives, encouraged preventive care services and site-of-service payment incentives and there is much for health care organizations to consider and address.

In our webcast, presenters discussed in detail OPPS and professional fee schedule changes, along with proposed changes to quality programs impacting hospital and health systems. While these changes are vast and somewhat daunting, presenters stressed the following critical areas:

  • Organizations must note pertinent changes in coding around procedures and services. A careful look at coding, misvalued and new codes, can impact practice management and reimbursement.
  • Centers of Medicare and Medicaid Services (CMS) is looking to track services provided in off-campus, provider-based clinics.
  • The definition of colorectal cancer screening is being reviewed and accompanying anesthesia services scrutinized.
  • Payment of secondary interpretation of images is another service area being reviewed and may be included for payment in the near future in order to reduce duplicate imaging tests.
  • CMS is driving improvement in chronic care management and there will be potential reimbursement for chronically ill patients in 2015.
  • And regarding the topic of the Physician Quality Reporting System, note the following:
  • Incentive payments end in 2014. Reporting for payment adjustments begins in 2015.
  • Alignment is expected with other quality reporting programs such as the Electronic Health Record Incentive Program, Physician Value-Based Payment Modifier and the Medicare Shared Savings Program.

And finally, regarding insights discussed related to the Medicare Shared Savings Program, presenters indicated:

  • CMS established a Medicare Shared Savings Program to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs in an Accountable Care Organization (ACO).
  • Individual providers and suppliers continue to bill and receive Medicare FFS as usual.
  • CMS assesses ACO performance yearly on quality performance and against a financial benchmark to determine shared savings.

This summary just scratches the surface of what presenters outlined in the full webcast. For more information and discussion of the many coding changes and their impact on practice management and resulting revenue consequences, listen to the entire webcast, Part 2 – Ambulatory payment update, or contact your RSM health care consultant.

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