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Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule Released by CMS

The recently released final rule from the Centers for Medicare and Medicaid Services (CMS) regulating outpatient hospital payments under the prospective payment system (OPPS) included several modifications to those quality measures tied to payment, and also specified principles to be utilized in future quality measure determinations.  The rule, updating Medicare payment policies and rates for hospital outpatient and ASC services, takes effect January 1, 2013, and provides guidance for hospital outpatient departments and ambulatory surgical centers with regard to quality measures under OPPS.

The final rule deviates from the proposed rule with regard to the quality reporting program for these outpatient hospitals. While the final rule did not add measures to those already finalized for payment determination for CY 2013, one measure was removed, another was altered to delay data collection, and data collection deferment was confirmed for another measure.

The rule also finalized the following: (1) revisions to procedural requirements for how data relating to quality is reported; (2) the retention of quality measures approved in prior payment determination periods, unless the measures have been modified (including deletion or suspension); and (3) revisions to the ASC Quality Reporting program.

The final rule is to be published in the November 15 Federal Register and a CMS fact sheet regarding the final rule may be accessed here. Additional information is also available in the Bloomberg BNA article, "Outpatient Hospital Payments to Increase 1.8 Percent Under Final CY 2013 CMS Rule



About this Author

The Barnes & Thornburg Healthcare Department regularly represents physicians, medical groups, managed care organizations, hospitals, nursing homes, and national healthcare-related associations located around the country. Given our healthcare practice, we understand the unique commercial and regulatory environment in which healthcare organizations operate. Our attorneys bring their problem-solving and consensus-building skills to listen carefully to the goals of their clients and recommend practical solutions.