CMS releases outpatient payment system, proposes 5th level to imaging APC families

CMS released a proposed rule for changes to the 2018 hospital outpatient payment system (OPPS) on July 13, with a 60-day comment period to begin soon.

CMS updates OPPS each year for changes in payment policies, rates and quality provisions for Medicare patients treated at hospital outpatient departments or surgical centers.

“These changes require innovative strategies, and we look forward to receiving stakeholder comment and incorporating new ideas in our final rule this fall,” said CMS Administrator Seema Verma, MPH, in a statement. “Additionally, the proposed rule takes a critical step towards fulfilling President Trump’s promise to lower the cost of drugs, particularly for Medicare beneficiaries.”

The proposal includes adding a fifth level to the imaging APC families. Level 4 imaging APC would be split, so the new level 4 would include higher volume, lower cost services and level 5 would include lower frequency services with higher costs.

CMS had been planning to end its transition policy on the use of CT and MR cost data in 2018 to begin estimating imaging APC relative payment weight with costa data from all providers. But comments from the industry, including the American College of Radiology, led to CMS adding a year to the transition, so the change is now set to take effect in 2019.

“Earlier this year, ACR raised concerns regarding using claims from all providers to calculate CT and MRI cost-to-charge ratios (CCRs) because many providers continue to use the ‘square feet’ cost allocation method and that including claims from such providers would cause significant reductions in imaging APC payment rates,” according to the ACR. “In response to ACR’s concerns, CMS is proposing to extend the transition policy an additional year and not use claims that include the square foot cost allocation method.”

The American College of Radiology has posted a summary of the tweaks that could impact radiologists and radiology practices. HealthExec has provided industry-wide perspective of the HOPPS rule and the 2018 Physician Fee Schedule.