American Society of Hematology

ASH Releases Analysis on Impact of Medicare Proposed Rules on Hematologists

Published on: July 25, 2013

On July 8, 2012, the Centers for Medicare & Medicaid Services (CMS) released two major Medicare proposed rules impacting payment for physician and hospital outpatient services in 2014. ASH will submit comments to CMS on the proposed rules by the September 6 deadline and would like to incorporate feedback from the Society's practice-based members. Review ASH's detailed analysis of the key issues and potential impact that the proposed rules will have on hematology and please contact ASH Government Relations and Practice Manager Stephanie Kaplan by August 16 with any comments you have about the proposed rule.

  • ASH Analysis of the Proposed Medicare Physician Fee Schedule (MPFS)
    CMS is proposing several changes to the physician fee schedule that will result in a net overall reduction in payment of 1 percent for hematology-oncology services. Modest changes are proposed for office-based evaluation and management (E/M) services while hospital visit and critical care codes will see increases of about 3 percent. Reductions are proposed for infusion codes, bone marrow biopsy and aspiration procedures. As in past years, the MPFS rule does not address the Sustainable Growth Rate formula driven payment reductions that will occur unless Congress takes action before the end of the year.
  • ASH Analysis of the Proposed Hospital Outpatient Prospective Payment System (OPPS)
    Medicare payments made under Hospital Outpatient PPS cover facility resources including equipment, supplies and hospital staff, but do not include services of physicians or non-physician practitioners paid separately under the Medicare Physician Fee Schedule. CMS is proposing major changes in the packaging of services paid for under OPPS to give hospitals greater incentives to use the most cost efficient items and services to meet patient needs. These proposals will significantly impact the billing for blood transfusion services, apheresis, stem cell processing and drug administration services.
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