Tag archives: OPPS

CMS issues Calendar Year 2022 OPPS/ASC Payment System final rule

On November 2, 2021, the Centers for Medicare & Medicaid Services (“CMS”)released its Calendar Year (“CY”) 2022 Medicare Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgical Center (“ASC”) Payment System final rule. This final rule is scheduled to be published in the Federal Register on November 16, 2021. In the final rule, CMS implements … Continue reading

CMS Publishes 2021 Hospital OPPS and ASC Final Rule

By Jeff Wurzburg (US) and Thomas Dowdell (US) on December 4, 2020 Posted in General, Regulatory

The Centers for Medicare & Medicaid Services (“CMS”) has published the Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgery Center (“ASC”) final rule for CY 2021. CMS finalized an annual increase OPPS and ASC rates of 2.4 percent for CY 2021, based on a 2.4 percent market basket update and without a cut for … Continue reading

Court of Appeals upholds 340B Reductions

By Thomas Dowdell (US), Mark Faccenda (US) and Jeff Wurzburg (US) on August 4, 2020 Posted in News from DC

On Friday July 31, 2020 the U.S. Circuit Court of Appeals for the District of Columbia Circuit reversed the federal district court and permitted reimbursement cuts for drugs purchased through the 340B Drug Discount Program.… Continue reading

CMS Publishes CY 2020 OPPS & ASC Price Transparency Requirements Final Rule and Transparency in Coverage Proposed Rule

By Mark Faccenda (US), Jeff Wurzburg (US) and Thomas Dowdell (US) on November 20, 2019 Posted in General, News from DC, Regulatory

On November 15, the Centers for Medicare & Medicaid Services (CMS) published the Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Changes Public final rule and the Transparency in Coverage proposed rule. CMS intends through this rulemaking to increase price transparency … Continue reading

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

By Thomas Dowdell (US), Mark Faccenda (US) and Jeff Wurzburg (US) on November 11, 2019 Posted in FDA & Food Safety, News from DC, Regulatory

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

By Mark Faccenda (US) and Jeff Wurzburg (US) on October 25, 2019 Posted in Enforcement, News from DC, Regulatory

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

By Thomas Dowdell (US) on September 18, 2019 Posted in Regulatory

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

By Thomas Dowdell (US) on July 30, 2019 Posted in Regulatory

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

By Thomas Dowdell (US) and Jeff Wurzburg (US) on July 26, 2018 Posted in Regulatory

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

By Thomas Dowdell (US) on November 3, 2017 Posted in News from DC

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

By Thomas Dowdell (US) on November 2, 2017 Posted in News from DC

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

By Thomas Dowdell (US) on December 14, 2016 Posted in News from DC, Regulatory

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

By Thomas Dowdell (US) and Mark Faccenda (US) on November 3, 2016 Posted in Regulatory

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

By Thomas Dowdell (US) on November 2, 2016 Posted in Regulatory

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

CY 2017 OPPS Proposed Rule sets new off-campus HOPD requirements

By Thomas Dowdell (US) and Mark Faccenda (US) on July 11, 2016 Posted in Regulatory

On July 6, 2016, CMS published its Calendar Year (CY) 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule. We provide a more detailed analysis of the significant proposals to our July 6 post below.… Continue reading

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

By Thomas Dowdell (US) on June 7, 2016 Posted in News from DC, Regulatory

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

By Thomas Dowdell (US) and Mark Faccenda (US) on February 8, 2016 Posted in News from DC, Regulatory

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

By on November 2, 2015 Posted in Regulatory

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