After a year-long delay, Medicare officials are implementing bundled payments for a number of services performed in hospital outpatient departments.
The new payments, which were finalized in the 2015 Medicare Hospital Outpatient Prospective Payment System rule, take effect on Jan. 1, 2015.
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The new payments take effect on Jan. 1, 2015.
The Centers for Medicare & Medicaid Services selected 25 primary services and their adjunctive services and supplies as comprehensive ambulatory payment classifications (C-APCs) and will provide a single payment under Medicare Part B. Medicare beneficiaries will pay a single copayment for the C-APC services.
The 25 C-APCs fall within 12 clinical families:
• automatic implantable cardiac defibrillators, pacemakers, and related devices.
• breast surgery.
• ENT procedures.
• cardiac electrophysiology.
• ophthalmic surgery.
• gastrointestinal procedures.
• neurostimulators.
• orthopedic surgery.
• implantable drug delivery systems.
• radiation oncology.
• urogenital procedures.
• vascular procedures.
For instance, Medicare has designated implantation of a drug infusion device as a C-APC (0227) with a bundled Part B Medicare payment of $15,566.
The final rule, which was released by CMS on Oct. 31, also reversed the CMS policy of requiring physician certification for all Medicare Part A hospital admissions.
Starting Jan. 1, a formal physician certification is required only for long-stay cases of 20 days or more, or in costly outlier cases. For most patients, the admission order, medical record, and progress notes will contain “sufficient information to support the medical necessity of an inpatient admission without a separate requirement of an additional, formal, physician certification,” according to the final rule.
The revision of the physician certification policy does not remove any of the requirements associated with Medicare’s controversial 2-midnight policy, which governs short-stay hospitalizations.
The final rule will be published in the Federal Register on Nov. 10.
mschneider@frontlinemedcom.com
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