ED Coding & Reimbursement Alert - 2003 Issue 31
Hospitals: CMS PROPOSES 3.8-PERCENT OPPS UPDATE
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Article Overview
This article reviews a proposed CMS outpatient payment rule affecting hospital outpatient reimbursement under the OPPS. It is aimed at hospital coders, revenue cycle staff, and outpatient reimbursement professionals who track annual payment updates and policy changes. The article covers broad adjustments to payment rates, packaging of certain items and services, pass-through payment status, ambulatory payment classification refinements, outlier thresholds, and treatment of orphan drugs and selected categories of drugs, biologics, and devices.
Why This Topic Matters
Proposed OPPS updates can affect hospital outpatient reimbursement, budgeting, and charge capture planning. Understanding the scope of the rule helps readers monitor changes that may influence payment methodology and service-specific payment treatment.
Article Sections
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Proposed OPPS payment update
Summarizes the proposed annual update to outpatient hospital payment rates and the broader effect on aggregate outpatient payments.
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Payment rate development and APC refinements
Describes the source data and methodological refinements used to develop relative payment rates for outpatient services.
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Pass-through payments and packaging of drugs, biologics, and devices
Covers proposed treatment of transitional pass-through items and the packaging or separate classification of selected categories of products.
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Outlier payments and orphan drugs
Addresses proposed changes to outlier payment thresholds, special treatment for certain facilities, and payment methodology for orphan drugs.
What You Will Learn
- What CMS proposed for the annual OPPS payment update
- How the rule affects outpatient hospital payment methodology
- What categories of drugs, biologics, and devices are affected by packaging or separate classification changes
- How the proposal addresses pass-through payments, outlier payments, and orphan drugs
Who Should Read This
- Hospital outpatient coders
- Hospital reimbursement and revenue cycle staff
- Healthcare finance professionals
- Medicare payment policy analysts
- Compliance teams involved in outpatient billing
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