CMS’ Medicare Payment Schedule Final Rule Affects Health IT

August 6, 2014 in News

On Monday, CMS released a final rule for the fiscal year 2015 Medicare payment schedule for general acute care and long-term care hospitals that aligns hospital reporting requirements with those of the meaningful use program, Clinical Innovation Technology reports (Walsh, Clinical Innovation Technology, 8/5).

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicare and Medicaid incentive payments.

The final rule will be published in the Federal Register on Aug. 22, and a majority of its provisions will take effect on Oct. 1.

Health IT-Related Details of Rule

Among other things, the final rule includes a market basket update of 2.9% for providers that in fiscal year 2013:

  • Submitted data related to quality of care measures; and
  • Demonstrated meaningful use of electronic health records (AHA News, 8/4).

According to the rule, the market-basket rate would decrease by one-quarter among hospitals that do not adequately submit quality data or participate in CMS’ EHR incentive program.

The agency increased the operating payments by 1.4% for acute care hospitals and by 1.1% for long-term care hospitals (Morgan/Kelly, Reuters, 8/4).

The final rule also includes several changes to Medicare codes for FY 2015, including new and updated codes.

For example, the final rule will create:

  • MS-DRG 266, which is related to endovascular cardiac valve replacement with MCC; and
  • MS-DRG 267, which is related to endovascular cardiac valve replacement without MCC.

In addition, the final rule CMS replaced MS-DRG 490 and 491 with the following new codes:

  • MS-DRG 518, which is related to back and neck procedures but excludes spinal fusion with MCC or disc device and neurostimulator;
  • MS-DRG 519, which is related to back and neck procedures but excludes spinal fusion with CC; and
  • MS-DRG 520, which is related to back and neck procedures but excludes spinal fusion without CC and MCC (Leppert, HealthLeaders Media, 8/6).

Overall, CMS said the rule will affect about 3,400 acute care hospitals and about 435 long-term care hospitals (Goad, The Hill, 8/4).

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