From the June 2017 issue of HealthCare Business News magazine

Physician Prospective Payment System
Around July 4, CMS will issue a proposed rule that updates payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2018. This proposed rule could have several new physician fee schedule policies. It will also address misvalued services and it will have proposed payment changes on codes that have been evaluated for 2018. Payments are based on the relative resources typically used to furnish the service.

Relative value units (RVUs) are applied to each service for physician work, practice expense and malpractice. These RVUs become payment rates through the application of a conversion factor, updated each year as specified in the statute. This proposed rule will also have a 60-day comment period and comments usually are due right after Labor Day.
Hospital Outpatient Prospective Payment System
Also, right around July 4, CMS will release the Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions and payment rates proposed rule.

Again, this year, a key proposal will be the continued implementation of Section 603 of the Bipartisan Budget Act of 2015, which will impact how Medicare pays for certain items and services furnished by certain off-campus outpatient departments. There may also be proposals regarding payment policies on the packaging of services and the continued use of comprehensive APCs. CMS may also propose new or reconfiguration of the payment classifications for various services. This proposed rule will also have a 60-day comment period and comments usually are due right after Labor Day.

About the author: Jill Rathbun is managing partner at Galileo Consulting Group.

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