New Medicare Rule Will Cut Payments to Hospitals for Some Surgeries

New Medicare Rule

A cost-cutting change in Medicare policy will reduce payments to hospitals for some surgical procedures and increase costs for patients, according to a March 21 report from the The Washington Post.

Before the change, CMS categorized 1,740 surgeries and other services as eligible for Medicare payments only if they were performed on beneficiaries who were admitted to the hospital as inpatients.

The new rule phases out this requirement. On Jan. 1, 266 musculoskeletal surgeries were taken off the list, and by the end of 2023, the list is scheduled to no longer exist.

CMS officials said the change was implemented to give patients more options and help lower surgery costs by inspiring more competition between hospitals and independent ambulatory surgical centers.

The agency pays hospitals less for services provided to outpatients, so the elimination of the list means CMS can pay less than it has been for the same surgeries at the same hospitals. Most of the time, it also means Medicare beneficiaries will be responsible for a larger portion of the bill, according to the Post.

Patients who are admitted to a hospital usually receive a package of services and are responsible to pay for 20 percent of physicians’ charges and Medicare’s hospital deductible, which is $1,484 for a stay of up to 60 days this year.

Under the new rule, patients will be responsible for 20 percent of the cost for each service they receive. For example, a patient who would have paid only for 20 percent of physicians’ charges and Medicare’s hospital deductible last year could now also be on the hook for an outpatient surgery payment, blood transfusion payment, facility fee and payments for any other services they need during their stay.

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