CMS Final 2014 Payment Rules Will Be Delayed

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Imaging providers anxious to see if the Centers for Medicare & Medicaid Services (CMS) will drop the proposed separate cost centers for CT and MRI from the final 2014 hospital outpatient prospective payment system (HOPPS) fee schedule will have to wait a little longer.

Because of the government shutdown, CMS has announced that instead of publishing its final 2014 HOPPS, Medicare physician fee schedule (MPFS), home health PPS and end-stage renal disease PPS rules on Nov. 1, as it traditionally does, it will issue the rules by Nov. 27.

Groups that represent radiologists and imaging providers — including the American College or Radiology (ACR) — have asked CMS to amend its final HOPPS rules in order to not create the separate cost centers for CT and MRI next year. The separate cost centers could save CMS a lot of money, but the reason is because the data used to create the cost centers was flawed, the ACR and others say. It is not because CMS was overpaying for these imaging services.

The problem with the cost data used to create the new cost to charge ratio is due to the fact that there has been no standard way for hospitals to report accurate numbers for the cost of operating high-end imaging equipment. Hospitals have over the years reported wildly varying data, the ACR said in a letter to CMS, and as a result, the new cost centers would recalculate payments in such a way that in many cases, simple X-ray imaging would be reimbursed at a higher rate than a sophisticated advanced imaging study.

Furthermore, because the law says that CMS must pay for all outpatient imaging at the HOPPS rate if it is lower than the rate in the MPFS, the new cost centers would not only impact hospitals. It would impact private practices as well.