NEWS YOU CAN USE: Cash In With Changes to Outpatient Services for 2005

Revamps to requirements for diagnostic tests mean more reimbursement
 
Bank on these changes for your outpatient services.

Ring in the New Year with a little bang for your bottom line: Some significant pay and policy adjustments await hospitals in 2005.

In a final rule scheduled in the Nov. 15 Federal Register, CMS says payments for outpatient services are projected to increase $1.5 billion, allowing high-quality preventive and treatment services in outpatient departments.
Here's what's officially on tap:
Screening exams. Payment increases have solidified: Pelvic and breast exams will rise by 1.7 percent, barium enemas 2.1 percent, bone density studies 4.5 percent, flexible sigmoidoscopies 6.8 percent, screening colonoscopies 8.3 percent, and glaucoma screening 9.9 percent.

Waiting periods. No more delays while codes and reimbursement are set for new drugs and biologicals - CMS says payment will be simultaneous with Food and Drug Administration approval.

Brachytherapy sources. Rates will be set on charges adjusted to cost, and definitions for new codes for high-activity brachytherapy sources will be established.

Co-pays. Your patients' maximum coinsurance rate for outpatient services drops slightly from 50 to 45 percent of the total hospital payment and will be reduced gradually to 20 percent.

Low-volume blood and blood products. Pay will increase via a 50/50 blend of the median costs used for payment in 2004 and in 2005. CMS will create individual ambulatory payment classifications (APCs) for these products.
 
Outlier payments. To be eligible for these payments in the outpatient setting, your cost of furnishing a service would have to exceed two thresholds: 1.75 times the payment of the APC, and $1,175 over the APC payment.

Diagnostic tests. CMS will eliminate current requirements that specify diagnostic tests that must be used in connection with patients who have asthma, congestive heart failure or chest pain.
You can submit comments during the 60-day period following publication. For more information, go to www.cms.hhs.gov/providers/hopps/2005fc/1427fc.asp.

 ED admissions staff won't have to double as border patrol.
Immigration and emergency care don't mix, CMS says. The agency has changed its tune on a July proposal that would require you to collect additional immigration information from undocumented aliens. The good news: You won't have to grill patients who come through your emergency department doors. But will you still get your share of the $1 billion reform-bill fund as promised?
 
In an Oct. 1 letter to the American Hospital Association, CMS Administrator Mark McClellan said that CMS had taken note of the "public health implications" raised by numerous hospitals in the comment period. Namely, hospitals worry that requiring proof of immigration status for Medicaid coverage would deter many patients from seeking emergency treatment.

Old plan: [...]

- Published on 2005-01-01