CMS recently proposed that as of January 1, 2013, hospital outpatient departments and ambulatory surgical centers would receive an increase in payments of 2.1% and 2.2%, respectively. These rate increases, however, would only apply to services provided to Medicare beneficiaries in these medical treatment facilities.
The underlying rationale for the proposed increase in payments to hospital outpatient departments and ambulatory surgical centers revolves around an effort by CMS to ensure Medicare beneficiaries have access to outpatient care deemed to be of high quality.
CMS projects that total payments to hospital outpatient departments under the Outpatient Prospective Payment System for calendar year 2013 will be $48.1 billion. In comparison, total payments to ambulatory surgical centers will equal $4.1 billion for calendar year 2013. The changes recommended by CMS in the proposed rule include providing beneficiaries with additional information regarding the Quality Improvement Organizations (QIO) review process. CMS hopes that the process can be streamlined to make it more responsive to complaints concerning quality of care. In addition, it is anticipated that the new process would accelerate resolution of quality complaints. To facilitate the goals of a streamlined, responsive, and accelerated resolution process, CMS proposes creating an alternative dispute resolution program entitled "Immediate Advocacy," the purpose of which would be to resolve beneficiary complaints. Furthermore, QIOs would be permitted to transmit and receive secured electronic versions of health information and allow them to release more elaborate information concerning the results of their investigations to beneficiaries and their caregivers.
CMS is accepting comments on this proposed rule until September 4, 2012, with a final rule expected to be issued on November 1, 2012.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
