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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M A R C H 2 0 1 6
• ASCs to MedPAC: Thanks for nothing. The
Medicare Payment Advisory Commission (MedPAC)
thinks that Medicare payments to ambulatory sur-
gical centers should stay flat next year. MedPAC's
reasoning: More patients are having surgery at
ASCs, so this should help offset any financial
hardships caused by the stagnant payments. This
isn't a new recommendation from MedPAC, which
has unsuccessfully recommended eliminating the
ASC payment update for several years, including in 2015 and 2016. The current recommendation
is not binding, and instead MedPAC will present their comments to Congress in March, with the
payment update finalized this fall. Meanwhile, MedPAC recommends a 1.65% payment increase
in hospital inpatient and outpatient services in 2017.
• Site-neutral payments coming in 2017. Certain off-campus hospital outpatient depart-
ments may face lower reimbursements starting in 2017. As part of the latest budget deal from
Congress, new physician-based centers located off of the main campus of a hospital will receive
reimbursement rates based on the ambulatory surgical center prospective payment system or
the Medicare physician fee schedule. The change affects those facilities established after Nov. 1,
2015, and located more than 250 yards from the hospital's main campus. HOPDs established
before the November cutoff date will be grandfathered in and continue to be reimbursed accord-
ing to the Medicare outpatient prospective payment system (OPPS) schedule. The move is meant
to curtail the practice of hospitals acquiring physician offices and outpatient facilities, and then
billing under the higher-rate hospital OPPS. While the government says that the move will save
Medicare millions, the American Hospital Association said in a statement that the site-neutral
payments "may endanger patient access to care, especially among patients who are sicker, the
poor, minorities and seniors who often receive care in hospital outpatient departments." The new
rule is scheduled to take effect Jan. 1, 2017. — Kendal Gapinski
Reimbursement Roundup
Coding & Billing
CB
