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CMS Sets 2014 Pay Rates for Hospital Outpatient and Physician Services

Cheryl Clark, for HealthLeaders Media, December 2, 2013

The total amount estimated in payments under the new schedule is $87 billion for 2014.

The 2014 physician fee schedule rule prompted a renewed call from the American Medical Association urging Congress to repeal the Sustainable Growth Rate formula, which is poised to cut physicians' pay by 24%.

"The clock is ticking" for the SGR, AMA president Ardis Dee Hoven, MD, said in a statement. "At stake are innovations that would make Medicare more cost-effective for current and future generations of seniors. These innovations are not possible if physicians are worried about drastic cuts to Medicare rates that have remained almost flat since 2001, while the cost of caring for patients has gone up by 25%."

Hospital Outpatient Prospective Payment System Rule

In the second rule, the federal agency is proposing a dramatic shift in how outpatient facilities and ambulatory surgical centers are paid so that the five levels of clinic visit codes are replaced with a single code.

That simpler code, the agency said in a news release, is more efficient and will "strengthen the long-term financial stability of Medicare," by "packaging" outpatient services in a way similar to the DRG system that pays hospitals for inpatient care.

Such bundled services include drugs, biologicals, and radiopharmaceutical supplies used in diagnostic tests and procedures. They include skin substitutes, lab services, device removal procedures and certain add-on procedures.

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