How does the recently issued 2018 Medicare Physician Fee Schedule impact your organization?
Get to know the following key provisions:
Payment Rate Changes.
- Off-Campus Provider-Based Departments: Except for dedicated emergency department services, services furnished in off-campus provider-based departments that began billing under OPPS on or after November 2, 2015, or that could not meet 21st Century Cures Act exception, will no longer be paid under OPPS – Result? Hospitals will receive payment of 40% of OPPS rate compared to current 50%.
- 340B Drug Pricing Program: Separately payable, non pass-through drugs and biologicals (other than vaccines) purchased through 340B Program will be paid at average sales price MINUS 22.5% – Result? Currently, payment is average sales price PLUS 6% resulting in 28.5% payment swing. Exemptions for CY 2018: rural sole community hospitals, PPS-exempt cancer hospitals and children’s hospitals.
- Telehealth Services: Additional covered services/codes were added including: visit to determine low dose computed tomography; health risk assessment; care planning for chronic care management; psychotherapy for crisis.
- Outpatient Therapeutic Services: Continuing non-enforcement of direct supervision requirements for outpatient therapeutic services for Critical Access Hospitals and small rural hospitals with less than 100 beds for CY2018 and 2019.
- Inpatient Only List: Removing total knee arthroplasty and five additional procedures.
- Ambulatory Surgical Center Quality Reporting: Removing three quality measures from 9 to 6 to more closely align with MIPS Scoring.
- Hospital Outpatient Quality Reporting Program: Removal of following 6 measures:
- OP-2: Median time to pain management for long bone fracture
- OP-26: Hospital outpatient volume data on select outpatient surgical procedures
- OP-1: Median time to fibrinolysis
- OP-4: Aspirin at arrival
- OP-20: Door to diagnostic evaluation by qualified medical professional
- OP-25: Safe surgery checklist use