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CMS Releases Proposed OPPS, Physician Fee Rules

Cheryl Clark, for HealthLeaders Media, July 9, 2013

The proposed Outpatient Prospective Payment System rule seeks to make more episode-based payments, while the proposed physician payment rule contains changes to the Medicare Electronic Health Record Incentive program.

The Centers for Medicare & Medicaid Services late Monday took several steps to make the way it pays for outpatient and physician services in 2014 more like the way it pays for inpatient care, with episode-based rates, and more "packages" of services.

The agency is striving to streamline payments in ways that "will remove incentives hospitals may have to provide medically unnecessary services or expend additional, unnecessary resources to achieve a higher level of visit payments."

In its 718-page proposed Outpatient Prospective Payment System rule, CMS projects a 1.8% increase for CY 2014, affecting payments for about 4,000 hospitals and their outpatient and emergency departments, inpatient rehabilitation and inpatient psychiatric facilities, long-term acute care hospitals, children's hospitals and hospitals specializing in care for cancer patients.

In a separate proposed rule, governing policies and payments to the Medicare Physician Fee Schedule, or Part B, for 2014, the agency wants to expand payment criteria from care that requires a face-to-face visit to care that involves "managing select Medicare patients' care needs beginning in 2015."

The proposed physician payment rule also changes quality reporting initiatives, the Medicare Electronic Health Record Incentive program, and the Physician Compare tool on Medicare.gov.

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