CMS Proposes Lower Reimbursement for Audiologists Serving Off-Campus Hospital Departments

August 1, 2018

Audiology services provided in off-campus hospital departments could be reimbursed at a lower fee schedule rate. The Centers for Medicare & Medicaid Services (CMS) issued the proposed rule [PDF] for services provided in outpatient hospital departments paid under the outpatient prospective payment system (OPPS) on July 25. The rule would affect payment for services provided on or after January 1, 2019, in approximately 3,800 facilities. Audiology services are included and paid through Ambulatory Payment Classifications (APCs). Under the Bipartisan Budget Act of 2015, audiology services is one of several services that when provided in off-campus hospital departments, the services will be reimbursed at the lower fee schedule rate opposed to the OPPS rate.

ASHA is analyzing the provisions of the rule and will submit comments before the September 24 deadline. 

Ambulatory Price Classifications for Audiology Services

Annual updates to the APCs paid under the OPPS were proposed to increase for audiology services (APCs 5721-5724; 5731-5735; 5741-5743; and 5161-5166). However, CMS is proposing to include the APCs, which are applicable to audiology services, to the policy that pays a “site neutral” payment if the service is provided in an off-campus hospital department. The site neutral payment policy is a requirement of Section 603 of the Bipartisan Budget Act of 2015. 

Annual Payment Update

For calendar year (CY) 2019, CMS proposes to increase the payment rates under OPPS by 1.25%. CMS estimates that total payments to OPPS providers will increase by approximately $4.9 billion compared to estimated CY 2018 OPPS payments. The only exception to the anticipated increase in payments is associated with services provided in off-campus hospital departments.

In addition, CMS has asserted that OPPS has been the fastest growing sector of Medicare payment systems under Medicare Parts A and B.

Questions?

Please contact Sarah Warren, MA, ASHA’s director of health care policy for Medicare, at swarren@asha.org.


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