Tag archives: OPPS

CY 2020 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) published its CY 2020 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule.  The final rule implements a number of significant changes to payment policies and rates for services furnished to Medicare beneficiaries in hospital outpatient … Continue reading

U.S. District Court Upholds Ruling that CMS Exceeded Its Statutory Authority in Reducing Medicare Payments for Clinic Visit Evaluation and Management Services Furnished in Hospital Excepted Off-Campus Provider-Based Departments

On October 21, 2019, U.S. District Judge Rosemary M. Collyer denied the government’s request to modify the Court’s previous ruling on September 17, 2019, that the Centers for Medicare & Medicaid Services (CMS) exceeded its statutory authority when it reduced Medicare payment rates for clinic visit evaluation and management (E&M) services provided to Medicare patients … Continue reading

U.S. District Court vacates CY 2019 OPPS final rule reducing Medicare payment rates for evaluation and management services furnished in hospital excepted off-campus provider-based departments

On September 17, United States District Judge Rosemary M. Collyer, United States District Court for the District of Columbia, ruled that CMS in its CY 2019 OPPS final rule reducing Medicare payment rates for evaluation and management (E/M) services furnished to Medicare beneficiaries in hospital excepted off-campus hospital provider-based departments exceeded its statutory authority and … Continue reading

CMS Publishes CY 2020 Proposed Rules for Hospital OPPS and ASC, MPFS, and ESRD and DMEPOS Policies and Payments

On July 29, the Centers for Medicare & Medicaid Services (CMS) published three proposed rules for Calendar Year (CY) 2020: Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule; Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule (MPFS); and End State Renal Disease … Continue reading

CMS proposes significant Medicare OPPS and ASC payment system changes for 2019

On July 25, 2018, the Centers for Medicare & Medicaid Services published its 2019 Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule.  A fact sheet describing the proposed rule is available here. The proposed rule can be accessed here. CMS proposes to update hospital OPPS payment rates … Continue reading

CMS issues 2018 Medicare physician fee schedule final rule and MACRA physician QPP final rule

On November 2, 2017, the Centers for Medicare & Medicaid (CMS) Services issued its Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) final rule.  The overall update to payments under the MPFS in 2018 will be +0.41 percent.  The 2018 MPFS conversion factor will be $35.99, an increase from $35.89 in 2017.  MPFS payment … Continue reading

CMS issues 2018 hospital OPPS and home health PPS final rules

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued its final hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system final rule for Calendar Year (CY) 2018.  On the same day CMS also issued its home health prospective payment system 2018 final rule.      OPPS payment rates will … Continue reading

President signs into law 21st Century Cures Act

On December 13th, President Obama signed into law the 21st Century Cures Act.  The legislation authorizes $4.8 billion for the National Institutes of Health to fund new initiatives in precision medicine, cancer, neuroscience, and regenerative medicine.  The bill also provides $500 million over ten years for the Food and Drug Administration for the development of … Continue reading

CMS Issues CY 2017 Final Rule

On November 1, 2016, CMS issued its Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) final rule with comment period. CMS also issued an interim final rule with comment period that establishes Medicare Physician Fee Schedule (MPFS) rates for certain items and services furnished by certain hospital off-campus outpatient departments. Significant provisions of the … Continue reading

CY 2017 OPPS Final Rule and Hospital Off-Campus Outpatient Department Payment Implications

On Tuesday, November 1, CMS published its Calendar Year 2017 Outpatient Prospective Payment System (OPPS) final rule with comment period.  The final rule includes provisions implementing the Bipartisan Budget Act of 2015, Section 603.  On the same date CMS also issued an interim final rule with comment period that establishes Medicare Physician Fee Schedule (MPFS) … Continue reading

U.S. House of Representatives approves legislation affecting off-campus hospital outpatient department Medicare payments

On November 2, 2015, President Obama signed into law the Bipartisan Budget Act of 2015 (BBA 2015).  BBA 2015, Section 603 generally provides that beginning January 1, 2017, off-campus hospital outpatient departments (HOPDs) will no longer be paid under the Medicare outpatient prospective payment system (OPPS) but rather under another applicable payment system, provided the … Continue reading

House Committee on Energy and Commerce seeks comments on changes to payments for services furnished in hospital new off-campus outpatient departments

On November 2, 2015, President Obama signed into law the Bipartisan Budget Act of 2015 (Act). Section 603 of the Act reduces Medicare payments to newly-enrolled provider-based, off-campus hospital outpatient departments (HOPDs), off-campus defined as a facility that is more than 250 yards from a hospital’s main buildings or a remote location of a hospital. … Continue reading

CMS issues OPPS final rule for CY 2016

On October 30, 2015, CMS issued its calendar year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule (collectively, OPPS rule). In the final rule, CMS (1) updates payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs), ASCs and partial … Continue reading
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