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CMS Issues Outpatient Policy and Payment Changes

CMS finalized the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center rule on Thursday, November 1, 2012.

The final rule (which is over 1,200 pages and will be published in the Fed. Reg. on 11/15/12) updates the Medicare payment policies and rates for hospital outpatient and ASC services beginning January 1, 2013.

Rates and policies set in the calendar year (CY) 2013 final rule with comment period will increase payment rates for hospital outpatient departments by 1.8 percent. The increase is based on the projected hospital market basket—an inflation rate for goods and services used by hospitals—of 2.6 percent, minus 0.8 percent in statutory reductions, including a 0.7 percent adjustment for economy-wide productivity and a 0.1 percentage point adjustment required by statute.

The OPPS rule also contains a significant change from prior policy: as proposed, it bases relative payment weights on geometric mean costs rather than median costs. Basing the OPPS payments on mean costs better reflects average costs of services and aligns the metric used in rate-setting for the OPPS with the IPPS.

For CY 2013, ASC payment rates will increase by 0.6 percent—the projected rate of inflation of 1.4 percent minus a 0.8 percent productivity adjustment required by law. Medicare uses changes in the consumer price index for urban consumers (CPI-U) as the measure of inflation for ASCs.

The rule also makes changes to the quality-reporting program for hospital outpatient departments and for ASCs.

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