Small Pay Increases for Outpatient Departments, ASCs in 2013


Medicare officials are proposing small payment increases for hospital outpatient departments and ambulatory surgical centers for next year.

Under a proposed rule issued on July 6, the Centers for Medicare and Medicaid Services announced that hospital outpatient departments would receive a 2.1% increase, and ambulatory surgical centers (ASCs) would see a 1.3% pay bump.

The proposed payment rates would apply to outpatient departments at more than 4,000 hospitals and at about 5,000 ASCs that participate in the Medicare program. The CMS estimates that because of these new payment rates and other policy changes, the Medicare program will spend about $48.1 billion on payments to hospital outpatient departments and another $4.1 billion in payments to ASCs.

The proposed rule, which revises the Medicare hospital outpatient prospective payment system and the Medicare ASC payment system, will be published in the Federal Register on July 30. The CMS will accept public comment until Sept. 4. The agency said it plans to release its final rule by Nov. 1.

The proposed rule also makes several changes aimed at improving the beneficiary complaint review conducted by Quality Improvement Organizations (QIOs). These organizations exist in all states and territories, and are charged with investigating beneficiary complaints related to the quality of care received from Medicare providers.

Under the proposal, the CMS would create a new review process called "immediate advocacy" to investigate oral complaints quickly. This is a significant departure from the previous complaint resolution process, which required beneficiaries to submit written complaints and often took up to 150 days to complete. In the new process, the CMS wrote that through immediate advocacy, some complaints could be resolved on the same day. It would be the ideal process for complaints related to delays in obtaining medical equipment, such as wheelchairs.

The immediate advocacy process would be good for providers, the CMS said, because it would reduce the burden of a lengthy review process.

The CMS has already been trying the process out, and so far it has been positively received by beneficiaries and providers, they wrote in the proposed rule.

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