Hospital outpatient providers could see $6.2 bil pay bump in 2023

Hospital outpatient providers could see a $6.2 billion increase in Medicare reimbursements next year under a proposed rule issued Friday.

In addition, the draft regulation provides more details on the agency’s new rural emergency hospital program, which is designed to help facilities in remote areas remain open.

Medicare would pay 2.7% more for outpatient and ambulatory surgical center services in 2023 under the proposed rule. The agency also would extend reimbursement for behavioral telehealth care beyond the COVID-19 pandemic and would offer higher payments when providers purchase U.S.-made N95 respirators, which typically are costlier than foreign-made products. The rule offers insight into how CMS may respond to a recent Supreme Court decision on 340B payment cuts as well.

CMS proposed conditions of participation for the new rural emergency hospital designation last month that include eliminating acute care inpatient services. The draft outpatient payment regulation offers more insight into how the agency wants to run the rural emergency hospital program, which is designed to help facilities in remote areas remain open.

Facilities designated as rural emergency hospitals would be eligible for a 5% Medicare reimbursement boost. The outpatient payment rule proposes that this not translate into higher coinsurance costs for beneficiaries. In addition, that regulation states that all outpatient services these hospital provide would be deemed rural emergency hospital services, although they wouldn’t receive extra payments for other services. Under the proposal, rural emergency hospitals would get monthly facility payments that rise annually based on the hospital market basket.
CMS proposes extending exceptions under the self-referral law to allow physician ownership or investment interests in rural emergency hospitals. The statute known as the Stark law after late Rep. Pete Stark (D-Calif.) prevents physicians from directing Medicare patients to providers in which they have financial stakes. CMS suggests revising the policy to make existing exemptions applicable to compensation agreements to which rural emergency hospitals are parties, according to the fact sheet.
CMS also wants to reduce the administrative burden for critical access hospitals seeking rural emergency hospital status, which the agency believes could help ease provider enrollment into the new program.
The agency plans to release the final conditions of participation and payment policies for rural emergency hospitals in a single final rule this fall.

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