The Centers for Medicare and Medicaid Services (CMS) have released their final payment rule for Medicare programs, which will affect care and coverage for patients insured through Medicare. These rulings will go into effect in 2019, impacting practices for the year to come. With regards to anesthesia practice management, the final payment rule will institute policies that may impact pricing, reimbursement, and case management.
Medicare management of outpatient treatment is set to experience many changes in 2019. The Outpatient Prospective Payment System (OPPS), the central pricing mechanism for all outpatient procedures, is scheduled to undergo a rate increase of approximately 1.25%, as calculated by annual inflation, productivity, and service value additions. This new rate will extend to all CMS “Centers of Excellence”, as well as all Medicare providers that oversee outpatient surgical treatments. The updated rules are also provisioned to decrease the percent reimbursement allocated for out-of-network providers. Per this update, outpatient surgeries performed by out-of-network providers will be reimbursed at 40% of the national Medicare rate, creating a significant financial disadvantage for choosing out-of-network providers. Such an action can be attributed to the push for a more segmented healthcare market where patients select providers based on their coverage.