The American Gastroenterological Association, American College of Gastroenterology and American Society for Gastrointestinal Endoscopy developed a report on the key provisions from the CMS 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System updates.
Here are seven key notes on how the updates could impact GI:
1. The reimbursement for GI/endoscopy services was lowered, some cuts exceeding 17 percent. These cuts could affect access to care going forward.
2. There will be a .77 percent reduction in the Physician Fee Schedule to all services because CMS failed to meet the 1 percent net reduction target for misvalued codes in 2016; only .23 percent of the target was achieved.
3. CMS finalized proposals for new values for incomplete colonoscopies, which will be paid at one-half the value of a completed procedure with the same code.
4. There weren't any changes made in the Physician Quality Reporting and Value-based Payment Modifier. This year was the last year for PQRS as standalone programs. In 2019, there will be adjustments to payment for quality reporting and other factors under the Merit-Based Incentive Payment System and Alternative Payment Models, required by the Medicare Access and CHIP Reauthorization Act.
5. Hospital outpatient services conversion factor was lowered 0.3 percent; ASC payment was updated 0.3 percent using the consumer price index. CMS will restructure nine clinical families, including GI for the Ambulatory Payment Classifications.
6. ASCs will see 2 percent lower Medicare reimbursement if they do not successfully participate in the ASCQ program. There weren't any new measures for 2016.
7. CMS finalized a proposal to align colorectal cancer screening codes G0105 and G0121 payment, increasing payment for services to the same level as CPT code 45378. But, there will be a 3 percent decrease in facility payment and 2 percent decrease in ASC payment for colonoscopy codes under the restructuring.