July 26, 2014

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 the Author

Nita Garg, Health Care Attorney, Barnes Thornburg, Law firm
Staff Attorney

Nita Garg is an associate in Barnes & Thornburg LLP’s Chicago office and a member of the firm’s Healthcare Department. Ms. Garg assists clients with healthcare issues, including physician employment, physician-hospital contracting, Medicare and Medicaid reimbursement, and various state and federal regulatory matters, including fraud and abuse and HIPAA. 


Boost: AJAX core statistics

Legal Disclaimer

You are responsible for reading, understanding and agreeing to the National Law Review's (NLR’s) and the National Law Forum LLC's  Terms of Use and Privacy Policy before using the National Law Review website. The National Law Review is a free to use, no-log in database of legal and business articles. The content and links on are intended for general information purposes only. Any legal analysis, legislative updates or other content and links should not be construed as legal or professional advice or a substitute for such advice. No attorney-client or confidential relationship is formed by the transmission of information between you and the National Law Review website or any of the law firms, attorneys or other professionals or organizations who include content on the National Law Review website. If you require legal or professional advice, kindly contact an attorney or other suitable professional advisor.  

Some states have laws and ethical rules regarding solicitation and advertisement practices by attorneys and/or other professionals. The National Law Review is not a law firm nor is  intended to be  a referral service for attorneys and/or other professionals. The NLR does not wish, nor does it intend, to solicit the business of anyone or to refer anyone to an attorney or other professional.  NLR does not answer legal questions nor will we refer you to an attorney or other professional if you request such information from us. 

Under certain state laws the following statements may be required on this website and we have included them in order to be in full compliance with these rules. The choice of a lawyer or other professional is an important decision and should not be based solely upon advertisements. Attorney Advertising Notice: Prior results do not guarantee a similar outcome. Statement in compliance with Texas Rules of Professional Conduct. Unless otherwise noted, attorneys are not certified by the Texas Board of Legal Specialization, nor can NLR attest to the accuracy of any notation of Legal Specialization or other Professional Credentials.

The National Law Review - National Law Forum LLC 4700 Gilbert Ave. Suite 47 #230 Western Springs, IL 60558  Telephone  (708) 357-3317 If you would ike to contact us via email please click here.