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Medicare Compliance & Reimbursement

Reimbursement:

What The Future Holds For Your Medicare Payments

Published on Thu Mar 18, 2004

See how MedPAC's March 2004 Report to Congress will impact your bottom line.

How will Congress' Medicare debates this term affect your reimbursement? The latest pronouncement from the Medicare Payment Advisory Commission may offer an early glimpse.
 
MedPAC outlines updates for seven Medicare prospective payment systems as well as the Medicare Advantage program in its March 1 report to Congress.

Here's the breakdown of its proposals for the year: 
 
Inpatient and outpatient PPS:

  • updates equal to marketbasket index, and
  • elimination of outlier payments (outpatient PPS) with an amount equal to those payments returned to the base payment.
     
    Physician and outpatient dialysis payment systems:

  • updates equal to market basket less an allowance for expected productivity gains.

    Skilled nursing, home health and ambulatory surgical center payment systems:

  • no updates since access and supply of providers is "stable" and total payments exceed costs enough to offset growth in 2005,
  • development of a new classification system for the skilled nursing PPS so that payments better follow patients' costs, and reallocating payments from rehab payment groups to other groups until such a system can be developed,
  • further studies of the home health PPS to determine if changes would improve access for all types of beneficiaries, and
  • alignment of the payment system for ambulatory surgical centers with that of the outpatient PPS, as well as revision of the list of approved procedures.
     
    Medicare Advantage plans:
  • the Centers for Medicare & Medicaid Services should not offset the impact of risk adjustment on overall MA payments, and
  • enrollment should be allowed for beneficiaries with end-stage renal disease.

    To see the report go to www.medpac.gov.

    Lesson Learned: Certain provider types may be next in line for pay updates and policy improvements, if Congress takes MedPAC's advice.

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