Healthcare News: CMS releases 2023 OPPS final rule

Why This Topic Matters

The final rule affects outpatient reimbursement, service coverage, and reporting practices across multiple facility types. Readers can use it to understand which broad policy areas were finalized for 2023 and where coding and billing workflows may need review.

Article Sections

1. New Medicare provider type

   Introduces the broad CMS policy change affecting rural emergency hospitals and describes the type of providers implicated. It also notes the timing of when this change begins to apply.

2. OPPS payment for 340B program drugs

   Summarizes the payment methodology changes discussed for drugs and biologicals tied to the 340B program. It also addresses budget-neutrality adjustments and related rulemaking timing.

3. Remote behavioral health services

   Covers telehealth-related outpatient payment policy for remotely furnished behavioral health services. It explains the general continuation of coverage after the public health emergency ends.

4. OPPS transitional pass-through payment for drugs, biologicals, and devices

   Reviews transitional pass-through payment activity for drugs, biologicals, and devices under OPPS. The section focuses on application counts and overall qualification status.

5. Dental services

   Discusses outpatient dental billing policy updates and the creation of a new HCPCS code for a specific category of dental rehabilitation services. It also notes clarification involving an existing CPT code used in dental billing scenarios.

6. Skin substitutes

   Summarizes CMS terminology and payment group changes related to skin substitute products. It also notes the handling of a deleted HCPCS code and a broader group of related codes.

7. Updates to OPPS and ASC payment rates

   Provides a brief overview of the annual outpatient and ambulatory surgical center payment rate update. It references the quality reporting condition tied to the update.