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CMS 2014 outpatient payment rule includes care coordination focus

Publish Date: 12/10/2013

According to a November 27 CMS news release, the CY 2014 final rule is intended to lower outpatient facility costs. The rule replaces the current five levels of hospital clinic visit codes for both new and established patients with a single code describing all outpatient clinic visits. In addition, in a move toward more coordinated care, outpatient services payments, including for ASCs, will see new bundling requirements that mirror hospital inpatient care rules. The packaging of supporting items and services into a single payment for the primary service is designed to force outpatient departments and ASCs to manage their resources to create more coordinated and affordable care. For surgical procedures, drugs and biologicals that function as supplies, including skin substitutes, when used for a procedure will be bundled into the single payment. Nurses play a critical role in facilitating this coordinated care through actions such as establishment of a care plan, communication between patients and providers, patient and caregiver communication, and medication management.

Additional changes include a payment increase of an estimated 1.7 percent for hospital outpatient departments, an increase of 1.2% for ASCs, and an addition of three new quality measures to begin reporting in 2016, two related to follow up surveillance after colonoscopy and one intended to measure outcomes of cataract surgery.

The final rule with comment period also establishes an encounter-based or “comprehensive” payment for certain device-related procedures, such as cardiac stents and defibrillators, but in a change from the proposed rule, delays its effective date to 2015.


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