CMS’ latest payment system changes and the implications for 2019 and beyond made waves on day one of the 2018 Revenue Integrity Symposium in Litchfield Park, Arizona. Attendees at the back-to-back general sessions on October 16 had the opportunity to ask revenue integrity experts questions about the 2019 outpatient prospective payment system (OPPS) and Medicare physician fee schedule (MPFS) proposed rules and revenue integrity hot topics, including price transparency, Medicare Advantage contracting, noncovered services, and more.
The Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction proposed rule would make significant changes to the Conditions of Participation and could change the way hospitals work with competitive ambulatory surgery centers (ASC).
CMS’ 2019 OPPS proposed rule continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments (PBD) and expanding last year’s payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted PBDs.
Without the guidance and expertise of compliance, revenue can’t be considered truly accurate and audit-proof. By using a compliance work plan to weave compliance best practices and audit findings into revenue integrity, organizations can flip revenue integrity processes from reactive to proactive.
The 2019 Medicare Physician Fee Schedule (MPFS) proposed rule, released July 12, introduces policies that focus on expanding the framework for reporting E/M visits and removing certain process measures under the Quality Payment Program (QPP).
