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CMS PROPOSES POLICY, PAYMENT RATE CHANGES FOR SERVICES IN HOSPITAL OUTPATIENT DEPARTMENTS AND AMBULATORY SURGICAL CENTERS IN 2010 Hospitals would be able to bill Medicare for pulmonary and intensive cardiac rehabilitation services furnished in outpatient departments beginning January 1, 2010 under a proposed rule issued today by the Centers for Medicare & Medicaid Services (CMS ). The proposals, which would implement provisions of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), were contained in a notice of proposed rulemaking (NPRM) that would revise payment policies and update the payment rates for services furnished to beneficiaries during calendar year (CY) 2010 in hospital outpatient departments under the Outpatient Prospective Payment System (OPPS). Medicare currently pays more than 4,000 hospitals - including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals - for outpatient services under the OPPS, which also sets payment policies and payment rates for partial hospitalization services furnished by community mental health centers. CMS is projecting a market basket update for CY 2010 of 2.1 percent for outpatient departments, and estimates total payments of $31.5 billion under the OPPS in CY 2010. There are approximately 5,000 Medicare-participating ASCs. CY 2010 is the third year of a four-year phase-in of the ASC payment rates calculated under the standard ratesetting methodology and the first year for which CMS is authorized to apply an update to the conversion factor. CMS is projecting the percentage increase in the Consumer Price Index for All Urban Consumers that would update the ASC conversion factor to be 0.6 percent. Total CY 2010 payments to ASCs are estimated to be $3.4 billion. For more information, click here. Press Release - 7/2/2009 Top 10 Children's Hospitals According to U.S. News and World report, out of the 56 medical centers ranked, only these 10 (listed alphabetically) were ranked in all 10 specialties. Press Release - 7/1/2009 How Much Money Could Be Raised by Limiting the Tax Exclusion for Employer-Sponsored Insurance? One of the thorniest questions about national health reform is how to pay for it. A new analysis from the Urban Institute examines eight options that would reduce the tax exclusion for employer-sponsored health insurance, provides one-year and 10-year revenue estimates and identifies who would be affected. According to the authors, limiting the tax exclusion for employer-sponsored insurance could be an important component of financing health reform. For instance, an initial cap set at the 75th percentile of premiums and allowed to change with the gross domestic product, would generate $224 billion over 10 years, while maintaining 90 percent of the existing subsidy. Under every option examined, after-tax income would fall less than one percent in 2010. While the burden would increase in subsequent years, the average percentage changes in after-tax-income would be relatively modest for most income groups. The researchers caution that while limiting the tax exclusion could produce substantial revenue, it would do little to constrain health-care costs since most of the exclusion would remain in place. For more information, click here. Press Release - 5/29/09 SMA Informatics announces the immediate availability of 2009 IPPS, OPPS, ASC,IPF calculators displaying Expected Medicare Payments. The new files contain the Expected Medicare Payment by facility by payment code • IPPS calculator for CY2009Q2, all IPPS hospitals by MS-DRG (Last update 5/29/2009) • ASC calculator, each participating ASC by HCPCS (Last update 1/10/2009) • OPPS calculator, all OPPS providers by APC (Last update 1/10/2009) • IPF calculator, each participating IPF by MS-DRG (Last update 1/10/2009) To purchase defined extracts from either national data file at the level of a cluster of peer providers, self selected regional provider set or complete index of all facilities in a state contact: SMA08_Data@smainformatics.com or Call 804.344.8111 |
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