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Medicare Updates|Policies and Rates

WASHINGTON (CN) - The Centers for Medicare & Medicaid Services (CMS) have revised the Medicare prospective payment system to update payment rates and reporting requirements for hospital outpatient departments, ambulatory surgical centers, and inpatient rehabilitation facilities for 2013, and will continue the electronic reporting pilot for the Electronic Health Record, according to a recent final rule.

Many of the changes were made to bring the Medicare payment system into alignment with provisions of the Affordable Care Act. The changes affect hospitals paid under the Outpatient Prospective Payment System (OPPS) as well as Community mental health centers (CMHCs) and Ambulatory surgical centers (ASCs). The agency estimates that most hospitals paid under the OPPS will see "a modest increase or a minimal decrease" in payment for services in 2013 with an expected 1.9 percent increase for all services over what was paid in 2012.

The agency estimates that some urban hospitals will experience a payment increase of 8.3 percent due to increased payments for partial hospitalization, group psychotherapy and hemodialysis services. CMHCs may see a decrease of 4.4 percent due to a decrease in estimated costs. The updates to the ASC payment system for 2013 will affect each center individually, depending on the mix of patients who are Medicare beneficiaries and the payment changes for the procedures offered by those centers, the rule said.

In addition to new payment rates, the agency decided to continue the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program "exactly as finalized for 2012" and made changes for the Quality Improvement Organizations (QIOs), including the secure transmission of electronic medical information, and beneficiary complaint resolution and notification processes, according to the CMS.

The agency maintains that "the use of an electronic infrastructure that supports the use of EHRs by eligible hospitals and CAHs [Critical access hospitals] to meet the requirements in various CMS programs" will reduce reporting burdens simultaneously with the submission of quality data "to provide a foundation for establishing the capacity of hospitals to send, and for CMS, in the future, to receive, quality measures via hospital EHRs for the Hospital IQR [Inpatient Quality Reporting] Program's measures.

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