Medical Billing Blog

CMS issues 2014 Outpatient Facility Policy and Payment Changes

Posted by Scott Shatzman on Fri, Jan, 10, 2014 @ 07:01 AM

facility charge resized 600Last November, CMS released a final CY 2014 hospital outpatient and ambulatory surgical center (ASC) payment Final Rule.  Most significantly, “CMS will replace the current five levels of hospital clinic visit codes for both new and established patients with a single code describing all outpatient clinic visits.” CMS believes that a single code and payment is administratively simpler for hospitals and “better reflects hospital resources involved in supporting an outpatient visit.” 

 

CMS is also expanding efforts to bundle more outpatient services under a single payment because the agency believes this will “encourage more efficient delivery of outpatient facility services.”

 

Examples of the types of items and services that will be included in a single payment include drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or procedure; drugs and biologicals that function as supplies when used in a surgical procedure, including skin substitutes; certain clinical diagnostic laboratory services; certain procedures that are never done without a primary procedure (add-ons); and device removal procedures.

 

As part of this broader proposal to consolidate payment for larger groups of services, the final rule with comment period also establishes an encounter-based or “comprehensive” payment for certain device-related procedures like cardiac stents and defibrillators, but in a change from the proposed rule, delays its effective date to 2015.

 

Thanks to Bill Finerfrock, Zhaneta Mansaku, and Kirk Shields at HBMA for writing this article.