- Implementation of documentation and coding adjustments for inpatient prospective payment system (IPPS) hospitals to recoup purported overpayments associated with the transition to Medicare Severity Diagnosis Related Groups (MS-DRGs). (Section 631). According to the Congressional Budget Office (CBO) Report this will cost hospitals approximately $10.2 billion in the next five years.`
- Rebasing of the state disproportionate share hospital (DSH) allotment effective in 2021 resulting in approximately $4.2 billion in savings. (Section 641).
In addition, the Act includes a provision extending one aspect of the statute of limitations for Medicare to recoup non-fraudulent overpayments from providers from three years to five years. (Section 638). A discussion of this provision can be found in the accompanying article entitled “Extension of Time for Overpayment Recoveries in Fiscal Cliff Law Not as Broad as it Sounds.”
Below is a short list of other key provisions of the Act that impact health care providers:
- Extension of the floor on the Medicare physician work geographic practice cost index through December 31, 2013. (Section 602).
- Extension of the outpatient therapy caps ($1,900 for speech-language/physical therapy combined, and $1,900 for occupational therapy) and exceptions process through December 31, 2013. (Section 603).
- Increasing the multiple procedure payment reduction for therapy services performed on the same day from 25% to 50%, effective April 1, 2013. (Section 633).
- Extension of the following ambulance payment provisions: (1) 3% increase for ground transports originating in rural areas and 2% for transports originating in urban areas; (2) treatment of air ambulance services as rural in any area designated as rural as of December 31, 2006, through June 30, 2013; and (3) increases in the base rate for ground transports originating in areas within the lowest 25th percentile of all rural areas (i.e., “super rural” bonus). (Section 604).
- 10% reduction in fee schedule payment for non-emergency transports for ESRD patients requiring renal dialysis services. (Section 637).
- Extension of payment adjustments for qualifying low-volume hospitals and Medicare-dependent hospitals. (Sections 605 and 606).
- Equalizing payments for stereotactic radiosurgery procedures furnished under the Medicare outpatient prospective payment system (OPPS). (Section 634). Stereotactic radiosurgery is a specialized form of radiation therapy that targets well-defined tumors without effecting nearby tissues. CBO estimates this will save Medicare approximately $400 million in the next ten years.
- Adjustment of the equipment utilization factor used in setting payment for imaging services in Medicare from 75% to 90%. (Section 635).
- Rebasing Medicare end stage renal disease (ESRD) bundled payments to incorporate findings relating to changes in behavior and utilization of dialysis drugs as set forth in a report issued by the Government Accountability Office (GAO). (Section 632). CBO estimates this will result in $4.9 billion in savings to the Medicare program over the next ten years.
- Implementation of a competitive bidding process for diabetic testing supplies, including diabetic test strips. (Section 636).