American College of Gastroenterology Breaking News

CMS Releases HOPPS/ASC Final Rule for CY2017

Today, CMS released the 2017 final rule that includes policy and payment changes for the Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Centers Payment System (ASC).

ACG, AGA and ASGE are currently reviewing the details of the final rule and will provide a more extensive summary soon. 

In the final rule (which will appear in the November 14, 2016 Federal Register), CMS describes the recommended changes to the amounts and factors used to determine the payment rates for Medicare services paid under the HOPPS. Here's a quick summary of those recommendations:

 ASC Conversion Factor — Using the Consumer Price Index for all urban consumers (CPI-U), CMS is increasing payment rates under the ASC payment system by 1.9 percent for ASCs that meet the quality reporting requirements under the ASC Quality Reporting Program.  This increase is based on a projected CPI–U update of 2.2 percent minus a multifactor productivity adjustment required by the Affordable Care Act of 0.3 percentage point.  For ASCs not meeting the quality reporting requirements, the update will be -0.1 percent in 2017.

 HOPD Conversion Factor —  Using the hospital market basket, CMS is increasing payment rates under the Hospital Outpatient Department by 1.65 percent (which is 2.7 percent, the estimate of the hospital inpatient market basket percentage increase, less the 0.3 percentage point MFP adjustment, and less the 0.75 percentage point additional adjustment). CMS is using a conversion factor of $75.01.

 Ambulatory Payment Classification (APC) Adjustments — CMS has finalized 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 payment rates for 2017 and will post them soon.

Site Neutral Payment— CMS finalized policies that require certain items and services furnished by certain off-campus hospital outpatient departments will no longer be paid under the OPPS beginning January 1, 2017. Currently, Medicare pays for the same services at a higher rate if those services are provided in a hospital outpatient department rather than a physician’s office. We will provide more details regarding the items and services impacted by these provisions in our detailed summary of the rule.

Watch your email for more detailed summary.  We expect the 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 finalize a plan for removing the value of moderate sedation from the codes that include the value, impacting the majority of GI endoscopy codes.



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