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January 25, 2018


Four Tests Added to List of CLIA Waived Tests

In early January, the Centers for Medicare and Medicaid Services (CMS) announced new waived tests... Learn More


New and Revised Vaccine Codes Added to 2018 CPT Code Book

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OIG Recommends Measures for Curbing Opioid Misuse and Fraud

Office of Inspector General testimony before the House Committee on Ways and Means in January ... Learn More


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Medical Coding News Archives

Outpatient and ASC Final Rules Released

 
November 11, 2008:

Among the most significant elements of the October 30 final rule updating the outpatient prospective payment system and the ambulatory surgery center payment rates for 2009 are reduced payment for lack of quality measures, and new quality measures, imaging composite ambulatory payment classifications, and emergency visit APCs.

  • The Centers for Medicare and Medicaid Services will reduce the calendar year 2009 payment update factor by two percentage points for most services for hospitals that were required to report quality measures but failed to meet the requirements of the Hospital Outpatient Quality Data Reporting Program (HOP QDRP) for calendar year 2009. Beneficiary cost-sharing for these services will also be reduced. The reduction will not apply to payments for separately payable pass-through drugs and devices, separately payable drugs and biologicals, separately payable therapeutic radiopharmaceuticals, brachytherapy sources that are paid at charges adjusted to cost, and services assigned to new-technology APCs.

  • CMS is increasing the number of measures that hospitals are required to report from the current seven to a total of 11 measures in 2009.

  • Five imaging composite APCs will encourage imaging efficiencies under the OPPS by providing a single APC payment when two or more imaging procedures using the same imaging modality are provided in a single session.

  • Four new APCs will be used to pay for visits to type B emergency departments.

  • CMS will pay for separately payable drugs and biologicals under the OPPS at the average sales price (ASP) plus 4 percent.

Deborah C. Hall
Clinical/Technical Editor

 

 
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