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Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule

08 November 2012
CMS released a single final rule addressing calendar year (CY) 2013 Medicare payments for hospital outpatient departments and ambulatory surgical centers (ASCs). Under the final rule, Medicare’s payment rates for hospital outpatient services will increase 1.8% overall.  CMS also plans to increase by 0.6% the payment rate to ASCs. CMS estimates that CY 2013 payments to hospitals under the OPPS will be approximately $48.1 billion and payments to ASCs will be roughly $4.074 billion.

The final rule includes several modifications to the quality reporting programs for hospital outpatient departments and ASCs. These include procedural requirements relating to the use of measures, and, for ASCs, a methodology for applying a 2% payment reduction when the quality program’s reporting requirements are not met.  No new measures will be implemented for either quality program.

CMS will reimburse hospitals for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals at the statutory default of average sales price (ASP) plus 6 percent, the same rate that applies to drugs with pass-through status. 

CMS also will use the geometric mean costs of services within an Ambulatory Payment Classification group to determine the relative payment weights of services, rather than the median costs that the agency has used since the inception of the OPPS.

The OPSS and ASC final rule under the Medicare program (CMS-1589-FC) is scheduled for publication in the Federal Register on November 15, 2012.

Stuart M. Langbein

Stuart M. Langbein,

Washington, D.C.

Beth Halpern

Emily Stopa

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