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Home >  E-Weekly >  December 3, 2013

CMS Issues 2014 ASC, Hospital Outpatient Payment Changes

Published: December 2, 2013

ASCs will see a 1.2% increase in their Medicare payments and hospital outpatient departments will get a 1.7% bump, according to the federal insurer's final rule for calendar year 2014.

The Centers for Medicare and Medicaid Services' announcement, issued on Nov. 27 after a government-shutdown-sparked delay of nearly a month, noted that ASC rates would be docked 2% for facilities that failed to meet quality reporting program requirements.

The final rule added 3 criteria to the ASC quality reporting program, for which data collection will begin in 2014 and which will influence calendar year 2016 payments:

  • Endoscopy/Polyp Surveillance: appropriate follow-up interval for normal colonoscopy in average-risk patients
  • Endoscopy/Polyp Surveillance: colonoscopy interval for patients with a history of adenomatous polyps, avoidance of inappropriate use
  • Cataracts: improvement in patient's visual function within 90 days following surgery

The hospital outpatient quality reporting program will also add the 3 criteria, plus 1 tracking employees' influenza vaccinations.

A provision in the hospital outpatient prospective payment system final rule allows the consolidation of payments for related items and services, such as drugs and biologicals used during surgery, into a single payment instead of separate claims. This change is intended to facilitate cost savings, say CMS officials.

As in previous years, the hospital outpatient prospective and ASC payment systems' rates are adjusted from 2 statistical sources, the federal government's projected hospital market basket and consumer price index for all urban consumers, respectively.

David Bernard

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