Revenue Cycle

CMS increases outpatient payment rates for preventive services

Patient Financial Services Weekly Advisor, November 5, 2004

Medicare beneficiaries will have more access to preventive benefits, quicker access to new technologies, and lower copayments for hospital outpatient services under a CMS final rule announced November 3.

The rule, effective January 1, 2005, gives hospitals a 3.3% inflation update in payment rates for outpatient services.

The inflation update, together with other policies contained in the final Outpatient Prospective Payment System (OPPS) rule, will increase projected Medicare payments to hospitals for outpatient services to $24.6 billion compared to $23.1 billion in 2004, CMS reported.

The rule also increases payment rates to hospitals for screening examinations that Medicare already covers, including

  • 1.7% increase for pelvic and breast exams to detect cervical and breast cancer
  • 2.1% increase for barium enema to detect colorectal cancer
  • 4.5% increase for bone density studies
  • 6.8% increase for flexible sigmoidoscopy to detect colorectal cancer
  • 8.3% increase for screening colonoscopy, also for colorectal cancer
  • 9.9% increase for glaucoma screening

    The rule will be published in the November 15 Federal Register. For more information, click here.

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