The Centers for Medicare and Medicaid Services will increase hospital outpatient provider reimbursements by $6.5 billion next year, the agency said late Tuesday in its final rule. Prospective Outpatient Billing System 2023.
The regulation also provides more detail on the agency’s rural emergency hospital program, which will provides a 5% Medicare reimbursement increase for covered outpatient services and an average facility fee payment of nearly $3.3 million next year if rural hospitals eliminate their inpatient beds. them, among other program conditions. Medicare beneficiaries will not be charged a copay for an additional 5% payment.
Leading up to the final rule, some rural hospital leaders doubt the initiative will have much of an impact, in part because critical access hospitals will have to forgo cost-based reimbursement. , rural hospitals will lose 340 billion VND in revenue and some facilities will have to get rid of their mental beds.
Emergency surgery centers will receive $230 million in Medicare reimbursement next year.
A spokesperson for Premier, the group’s purchasing and consulting organization, said it appreciated the hospital’s increase in outpatient provider rates, but it was not enough to cover the increase in home costs. provided.
Soumi Saha, Premier’s senior vice president of government affairs, said: “The truth remains that the 3.8% billing update is missing a reflection of the rising labor costs that hospitals have to experience. since the outbreak of the pandemic”.
The rule also updates 340B payments, after the Supreme Court sided with the American Hospital Association in its challenge of the proposed pay cut. Medicare next year will restore the default price — the average selling price plus 6%, instead of the average selling price minus 22.5% effective January 1, 2018. CMS is still looking to apply the decision. determined by the Supreme Court on the calendar year before, the agency said in the rule.
Maureen Testoni, CEO of the hospital-backed association 340B Health, said Medicare has paid nearly 30% less to many 340B hospitals for drugs given to Medicare patients over the past four years.
“We are delighted to see that CMS has restored equity to the promising Medicare outpatient payment system. We look forward to working with CMS to compensate hospitals financially harmed by illegal OPPS payment cuts in 2018 through 2022,” she said.
Also in this rule, CMS established perpetual Medicare payments to hospital outpatients, who provide telemedicine services to patients in their homes.
The agency will remove 11 services from its inpatient-only list, a list of about 1,700 services for which Medicare will only pay for inpatients due to the complexity of the procedure, the patient’s physical condition, and more. patients or the need for at least 24 hourly postoperative recovery time. CMS began a three-year period in 2021 by removing 298 services from the list, but backed off late last year after heavy lobbying from hospital and physician associations over concerns. come back safely.
