ACR Preliminary Summary of HOPPS Final Rule

On Nov. 1, 2016, the Centers for Medicare and Medicaid Services (CMS) releasedits final rule with 60-day comment period for changes to the calendar year (CY) 2017 hospital outpatient prospective payment system (HOPPS). In this rule, CMS finalizes many of items from the proposed rule including a further restructure of the imaging ambulatory payment classifications (APCs), an expansion of its use of comprehensive APCs (C-APCs), a new modifier for reduction in film-based X-ray services and expanded definition of the applicable codes, and some loosening of their implementation of Section 603B to impose site-neutral payments for off-campus sites. Despite heavy opposition, CMS elected to move forward with a restructure of the 17 imaging ambulatory payment classifications (APCs) that exist for CY 2016 down to 7 for CY 2017. The seven include four APCs for imaging without contrast and three for imaging with contrast and consist of cardiology, echocardiography, radiology and any other specialty that would provide imaging services. Within this consolidation, CMS has also chosen to calculate a geometric mean cost of each study based on whatever data is available and sort them into the corresponding pricing categories purely by cost. This means that the original Congressional intent that studies be place in categories according to clinically similarity is of little consideration. As a result, the ACR is extremely disappointed that G0297 (Low dose CT scan (LDCT) for lung cancer screening)...
Source: American College of Radiology - Category: Radiology Source Type: news