tci Medicare Compliance & Reimbursement - 2004 Issue 38

Hospitals: Is CMS' OPPS Rate Undercutting Hospitals' Pay?

GAO: 'Payment for drugs, devices, services does not uniformly reflect hospitals' costs.'Many hospitals have noticed that their pay for new drugs and devices has dwindled under the outpatient prospective pay system. Drug and device reps say that OPPS reimbursement isn't covering hospitals' costs - and that could threaten patient access.So, why aren't hospitals getting a fair shake? In a September report, "Information Needed to Assess Adequacy of Rate-Setting Methodology for Payments for Hospital Outpatient Services" (GAO-04-772), the General Accounting Office says that flawed calculations of excluded claims are partly to blame. The Centers for Medicare & Medicaid...

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