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Agenda
 Key Themes and General Thoughts About Both Rules

 Part I: Review of Key OPPS & ASC Final Rule Changes

• General and Usual Updates
• Significant Changes Finalized for CY 2019

 Part II: Round-Up of Other OPPS Final Rule Changes

 Part III: Key Final Rule Changes from the Medicare Physician
Fee Schedule (MPFS)

 Part IV: International Pricing Index Model for Drugs

 Part V: Summary

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 Key Themes Across Both Rules
 Patient’s Over Paperwork
 CMS’s name for their set of initiatives designed to reduce
administrative and regulatory burden
 Meaningful Measures: the framework being applied to all quality
programs to remove redundant and ineffective quality measures

 Modernizing Medicare

 Drug Pricing

 Site Neutrality

 Price Transparency
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 Some Impressions of the Rules
 CMS had little time to review comments due to the late release of both rules but
had to adhere to publishing both final rules by early November
 CMS finalized majority of its proposals with some revisions and/or delay

 CMS’ responses and recap/summary of comments in these final rules feels very
different from previous years
 Comments reported by Medicare reflect “lots of support” for its various proposals

 Provider concerns/comments not well reflected in these final rules

 CMS also using proposed rules to make announcements about changes rather
than just issuing proposals
 Ex 1: Price transparency in the IPPS Proposed Rule
 Ex 2: New modifier –ER to be reported by off-campus provider based emergency
departments in the OPPS Proposed Rule

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 CY 2019 Final Rule Files
 OPPS Final Rule - download rule at: https://www.cms.gov/Medicare/Medicare-Fee-
for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-
Notices-Items/CMS-1695-
FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending
 Scroll down to download the display copy and the Addenda:
 Addendum A – list APCs, rates, etc.
 Addendum B – lists CPT codes, APCs, rates, etc.
 Addendum C –lists APC by CPT, etc.
 Addendum D – definitions of status indicators
 Addendum E –inpatient-only list
 Addendum J –related to CAPCs
 Other files also available for download

 MPFS Final Rule - download rule at: https://www.cms.gov/Medicare/Medicare-

Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-
Notices-Items/CMS-1693-F.html 5
• General and Usual Updates
• Significant Changes Finalized for CY 2019
• Site Neutral Payment Policies
• Expansion of Approved ASC Procedures

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 Final CY 2019 Market Basket
Update and Conversion Factors
 CMS proposes to increase the conversion factor by 1.35%
 Market basket increase of 2.9%

 Reduction of 0.8% for multifactor productivity

 Reduction of 0.75% from the Affordable Care Act

 Other adjustments (i.e., pass-through spending, outlier, and budget neutrality)

 $78.636*– current 2018 conversion factor for hospitals that meet quality
reporting requirements - $79.490 finalized for CY 2019
 $77.064*– current 2018 conversion factor for hospitals failing to meet
quality reporting requirements - $77.955 finalized for CY 2019

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 For more information visit www.skillacquire.us

 Thank You