Medicare Compliance & Reimbursement

Revamps to requirements for diagnostic tests mean more reimbursement.

Hospitals can ring in the New Year with a little bang for their bottom line: Some significant pay and policy adjustments are coming in 2005.
 
In a final rule published in the Nov. 15 Federal Register, the Centers for Medicare & Medicaid Services 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.