American College of Gastroenterology Breaking News

Proposed 2017 HOPD/ASC Rule Released Today 

This afternoon, CMS released the 2017 proposed rule that includes policy and payment changes for the Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Centers (ASC). ACG, AGA, and ASGE are currently reviewing the details of the proposed rule and will provide a more extensive summary soon.
In this proposed rule, CMS describes the recommended changes to the amounts and factors used to determine the payment rates for Medicare services paid under the HOPPS.
ASC Conversion Factor — Using the Consumer Price Index for all urban consumers (CPI-U), CMS proposes two conversion factors: one for ASCs meeting quality reporting requirements of 1.2 percent and one for ASCs not meeting quality reporting requirements of -0.8 percent in calendar year (CY) 2017.
Ambulatory Payment Classification (APC) Adjustments — CMS is proposing some additional modifications in APCs following its reorganization of all APCs that resulted in the restructuring and consolidation of the APCs that contain GI procedures in 2016. We are currently reviewing the list of services and proposed payment rates for 2017 and will post them soon.
CMS will accept comments on the proposed rule until September 6, 2016, and will respond to comments in a final rule to be issued on or around November 1, 2016. The proposed rule will appear in the July 14, 2016, Federal Register and can be downloaded HERE.
Watch your email for more GI reimbursement news. We expect the proposed Medicare Physician Fee Schedule to be released shortly, including proposed values for new moderate sedation services provided by the same physician who performs the underlying procedure. Additionally, we expect CMS will propose a plan for removing the value of moderate sedation from the codes that include the value, including the majority of GI endoscopy codes.
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