Medicare Announces 2013 Payment Rates

Hospital outpatient departments will see a 1.8% increase in their Medicare reimbursements next year, while ASCs get only a 0.6% bump, according to the final rule on facility payment policies that CMS issued Nov. 1.

The final rule, scheduled for publication on Nov. 15 and open for comment until Dec. 31, will take effect on Jan. 1 for calendar year 2013.

The Hospital Outpatient Prospective Payment System's 1.8% increase is based on a Hospital Market Basket rate projection of 2.6%, less 0.8 percentage points as required by law. CMS's proposed final rule, issued in July, suggested a net 2.1% increase.

As in previous years, ASCs' 0.8% increase is based instead on the Consumer Price Index for Urban Consumers (CPI-U) of 1.4%, less 0.8 percentage points in productivity adjustments as mandated by the Affordable Care Act. In July, the proposed final rule offered a net 1.3% increase.

For example, most high-volume ophthalmic services performed in ASCs will see slight increases. Cataract surgery (66984) will go from $963 in 2012 to $971.02 in 2013. Glaucoma surgery (66170) will go from $939 this year to $940.80 next year.

The announcement brought another round of protests from the ASC industry's chief booster. "We are extremely disappointed that CMS continues to undervalue ASC reimbursements by using the CPI-U to update ASC payments, a factor that even their own actuaries believe is inappropriate," says ASC Association CEO Bill Prentice in a statement. "Using different update factors for ASCs and hospital outpatient departments widens the gap between HOPD payments and ASC payments, further incentivizes a disturbing trend of conversions of ASCs to HOPDs and increases costs to the Medicare program, its beneficiaries and taxpayers who support the program."

David Bernard