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March 27, 2018

Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More

Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More

OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More

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Medical Coding News Archives

Outpatient Prospective Payment Rule Released

November 13, 2007:
The final rule on the outpatient prospective payment system describes new payment policies and quality measure reporting, and updates the rates for the revised ambulatory surgery center (ASC) payment system. The rule applies to services furnished during calendar year (CY) 2008.

Some of the issues addressed in the rule, released by the Centers for Medicare and Medicaid Services (CMS) on November 1, include:

Linking payment updates to quality measure reporting: Hospitals will be required to report seven consensus quality measures, including five emergency department acute myocardial infarction transfer measures and two surgical care improvement measures. Hospitals that are paid under the inpatient prospective payment system are required to report the applicable hospital outpatient quality measures to receive the full OPPS market basket update in CY 2009; otherwise, their CY 2009 update will be reduced by 2.0 percentage points.

Expanded packaging for CY 2008: The current packaging approach will be expanded to include guidance, image processing, and intraoperative services, imaging supervision, and interpretation services, diagnostic radiopharmaceuticals, contrast agents, and observation services.

Introduction of composite ambulatory payment classification (APC) groups: CMS is also adopting the use of composite APCs to “encourage efficiencies by providing one bundled payment for several major services.” According to CMS, composite APCs encourage even greater hospital efficiencies than expanding packaging by making a single payment for the totality of hospital outpatient care provided during an encounter.

Deborah C. Hall
Clinical/Technical Editor


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