Medicare Compliance & Reimbursement

Medicare patients could enjoy lower coinsurance rates for outpatient services.

The Centers for Medicare and Medicaid Services wants to pay hospitals more for most Part B drugs, biologicals and radiopharmaceuticals administered in their outpatient departments.

Acute care hospitals could receive a 3.2 percent inflation adjustment to their payment rates under the Outpatient Prospective Payment System in 2006, CMS announced July 18.

CMS' proposed rule contains policy changes and updated payment rates, including:
   Coinsurance rates will decrease gradually to 20 percent of the hospital's total payment for 12 additional medical and surgical ambulatory payment classifications.
   Sole community hospitals in rural areas may see an additional 6.6 percent payment adjustment.
   Medicare could pay 106 percent of the drug manufacturer's average sales price for Part B drugs administered in hospital outpatient departments.
   CMS proposes to pay an additional 2 percent over the Part B drug payment to cover pharmacy costs until 2008.

CMS also proposes to implement the Medicare Payment Advisory Commission's recommendations to Congress regarding payment changes for outpatient diagnostic imaging procedures.
 
When a hospital performs two or more procedures in the same CMS-identified imaging procedure "family," Medicare will pay for the first procedure in full and 50 percent of the second and subsequent procedures, according to CMS.

The proposed OPPS rule appears in the July 25 Federal Register, and CMS is taking comments on the rule until Sept. 16, 2005.