The National Association for Medical Direction of Respiratory Care

The Washington Watchline

CMS Aligns Physician and Hospital Financial Incentives

The Centers for Medicare and Medicaid Services (CMS) is implementing regulations in the proposed 2019 Physician Fee Schedule and the finalized 2019 Inpatient Prospective Payment System that will increase the interdependence between hospital administration and physician practice.

The 2019 Medicare IPPS and OPPS

On July 25, The Centers for Medicare and Medicaid Services (CMS) released the 2019 Outpatient Prospective Payment System (OPPS) proposed rule and on August 2 the Agency released the finalized Inpatient Prospective Payment Rule (IPPS). CMS has stated that it is focusing on regulatory reform and reducing the regulatory burden for physicians and hospitals. The finalized 2019 IPPS rule makes adjustments to the four hospital pay-for-reporting and value-based purchasing quality programs.

The Proposed 2019 Medicare Physicians Fee Schedule

On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule for the 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP). The Agency has submitted a number of new proposals including a significant change in the way outpatient care is to be documented and compensated, adding new codes for services furnished using telemedicine, increasing the weight of the cost performance category in the merit based incentive payment system (MIPS)  to 15% and adding another category to the MIPS low volume threshold.

MedPAC Proposes a Major Change to Compensation for Home Ventilators

In its June 2018 report to Congress, the Medicare Advisory Payment Commission (MedPAC) takes on “Issues in Medicare’s Medical Device Payment Policies” with recommendations to change the way in which home ventilators are reimbursed by Medicare. Specifically, the Commission has recommended that compensation for home ventilators be transferred to the Competitive Bidding Program (CBP). The Medicare Modernization Act of 2003, the legislation that established the CBP, exempted certain items from inclusion in the program.

DME and the New CMS Provider Documentation Manual

The Centers for Medicare and Medicaid (CMS) Center for Program Integrity has recently announced a new project related to its oversight of the use of durable medical equipment (DME). The Center is creating a Provider Documentation Manual that is to be accessed on the CMS web site with the purpose of ensuring that orders for durable medical equipment meet all existing regulations.

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