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View from the Hill - CMS rule to cut payments

August 21, 2015
From the August 2015 issue of HealthCare Business News magazine

There was concern that CMS would expand this proposal for CY 2016 and then more imaging services would not be paid separately, making the OPPS payment system almost exclusively like the inpatient/MS-DRG payment system where imaging services are included in the MS-DRG payment. While CMS did expand their packaging proposal to three additional APCs, two were for lab services and one was for minor procedures.

This is a good outcome for the imaging community. CMS also discusses in this proposed rule the continued use of Composite APCs to pay one amount when two or more imaging services of the same modality and family are performed on the same day for the same patient. CMS talks about only using claims to set the rate of the Composite APC that are claims with two or more imaging services and the process for cleaning and analyzing that data.

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Finally, CMS proposes the process that hospital outpatient departments will have to use to verify that their CT machines meet the MITA low-dose CT standard, so that those studies do not have their payments reduced starting in 2016. CMS proposes that hospitals use a modifier on their CT claims to attest that their CT machines meet the standards.

About the author: Jill Rathbun is managing partner at Galileo Consulting Group, in Arlington, VA. She will be commenting for DOTmed HealthCare Business News on issues of interest to health care professionals.

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