January 06, 2017

ACR Expresses Concerns about 2017 HOPPS Final Rule

The American College of Radiology (ACR) submitted critical comments on Dec. 22, 2016, to the Centers for Medicare & Medicaid Service (CMS) on the Hospital Outpatient Prospective Payment System (HOPPS) final rule.

Although CMS only formally accepted comments on the site-neutral policy in the final rule, the ACR felt it was important to express its concerns about APC consolidation and packaging policies that were finalized for 2017 without including adjustments or further transparency the College previously requested.

The ACR expressed its disagreement with CMS’ placement of many codes that will cause devastating reimbursement cuts for CT lung, MR, MRA and other advanced diagnostic imaging procedures.

The ACR is concerned that without being able to model CMS’ packaging methodology, it could not determine if relevant data may have been left out of the rate-setting process. The inability to model CMS’ packaging methodology also hampered the ability to discern the true effects of this new policy on hospital payments.

Finally, the ACR expressed deep concern about the effects of CMS’ new internally and unilaterally developed system for calculating site-neutral payments. As a result, CMS will pay non-excepted items and services at approximately half as much as OPPS rates.

The ACR will continue to work with CMS in the coming year to remedy these issues in an attempt to stabilize radiology payments to hospital outpatient facilities.