Thursday, July 13, 2017

CMS Posts CY2018 Proposed Rules for Physician and Hospital Outpatient Settings

After markets closed on Thursday, July 13, 2017, CMS released "inspection" or typescript copies of the Annual Rulemaking for both the Physician Office and Hospital Outpatient settings.   Comments due September 11.
  • Home page for new CMS rules, here.
  • Outpatient rule, here. 82 Fed Reg 33558-724 (167 pp).  CMS fact sheet, here.  
  • Physician office rule, here.  82 Fed Reg 33950-203 (254 pp).   CMS fact sheet, here.
Outpatient Rule

The outpatient rule includes proposed changes to the infamous CMS Laboratory Date of Service rule aka 14 Day Rule (page 33650ff).  CMS might allow labs to bill either only for ADLTs, or, for all genomic tests that are not otherwise bundled.  Other changes a proposal to cut 340B drug payments (see also a July 18 Hill hearing on 340B, here.)
  • Summaries at Beckers (here), American Pharmacists Assoc (here), Radiology Business (here), RevCycle (here), and National Law Review (here).
Physician Rule

The physician rule includes more specifications for the novel Diabetes Prevention Program (DPP; page 34129ff.)   CMS proposes it may consider reviewing "100% virtual" services under a new demonstration project (page 34171ff), which would "run in parallel with" the rest of the DPP Expanded Model.[*]   The DPP section runs almost 50 pages; payment would be tracked via 19 G-codes.

Other PFS topics include altering physician payments at "off campus" hospital affiliated sites (33978ff).  Note that physician quality reporting rulemaking is mixed between this rule and the June 20 MACRA rule (here).   There is a discussion of the new, Congressional mandated Appropriate Use Criteria (AUC) that must be consulted (preferably via EHRs) in the ordering of advanced imaging (34091ff).  Finally, CMS seeks comments on how to improve its criteria for E&M coding and grading (34078ff).
  • Summaries at Beckers (here), Medscape (here), Fierce Healthcare (here), Healthcare IT News (here), Healthcare Dive (here).

[*]  CMS gives the DPP its own separately titled press release, but the so-titled press release just describes the overall PFS rule with only a bland sentence that it includes DPP.
Informal aggregated web clippings, online here.