2014 HOPPS Proposed Rule Cuts Imaging Reimbursement

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According to an analysis by the American College of Radiology (ACR) the 2014 Medicare Hospital Outpatient Prospective Payment System (HOPPS) proposal released July 8 could cut hospital outpatient CT and MRI reimbursement by 18% to 38%.

In addition, the technical component payments for hospital outpatient CT and MRI would fall below the rates in the Physician Fee Schedule, which means that this would also become the de facto rate for in-office imaging. According to a provision in the Deficit Reduction Act, Medicare must reimburse at whatever rate is lower to save the government money.

The cuts are the result of the Centers for Medicare & Medicaid Services (CMS) finally adopting the long threatened separate cost centers for CT and MRI. The ACR stated that it has been following this issue since 2008 and providing research to CMS on the problems with making CT and MRI distinctly separate cost centers from the diagnostic radiology cost center. For example, one ACR analysis found that creating a separate CT cost center to calculate the technical payment for CTs would make the payment less than that for a chest X-ray.

For 2014, CMS proposes to use fiscal year 2011 cost data to establish the CT and MRI cost centers. The HOPPS proposal has a 60-day comment period, and the ACR stated it would submit comments on this and other issues in the proposal that affect radiology and radiation oncology.