Medicare pays for clinical diagnostic laboratory tests (CDLTs) under the CLFS. The CLFS provides payment for approximately 1,300 CDLTs, and Medicare pays approximately $7 billion per year for these tests. As of July 6th, 2016, some of the medicare & medicaid rules and policies are changing. Read Below for some facts and information about the upcoming changes:
- The 2017 Medicare physician fee schedule conversion factor will drop slightly, from 35.8043 to 35.7551.
- Family Medicine looks to be the big winner this year with a 3% increase
- Interventional Radiology will take a huge 7% hit.
- Pathology and Vascular surgery will also decrease by an average of 2%
- Telehealth will see an expansion of coverage there will be new codes for these services
- Zero-day global services are under increased study. These are the codes which are commonly billed with an E&M code along with the modifier -25
Proposed Hospital Outpatient Payment Changes for 2017
On July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule (CMS-1656-P). CMS is proposing a number of outpatient prospective payment policies that will improve the quality of care Medicare patients receive.
A key proposal in this year’s rule is to implement Section 603 of the Bipartisan Budget Act of 2015, which will affect how Medicare pays for certain items and services furnished by certain off-campus outpatient departments of a provider (hereinafter referenced as off-campus “provider-based departments” (PBDs)). In addition, CMS has listened to concerns raised by health care providers on the patient experience survey questions about pain management and is proposing to remove the Pain Management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for purposes of the Hospital Value Based Purchasing Program. In addition to the payment provisions and quality reporting program changes for the OPPS/ASC proposed rule, CMS has created other propositions.