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Proposed OPPS Rule Holds Significant Changes

Michelle A. Leppert, for HealthLeaders Media, July 10, 2012

While hospitals are likely to be pleased with CMS' proposal of ASP+6%, it is unlikely that most will agree that this payment level is sufficient to cover both drug acquisition costs and pharmacy handling costs, says Shah. "It will be interesting to see what sorts of comments CMS receives on its proposal."

CMS proposed no changes to evaluation and management codes or guidelines and reiterated that new and established designations for patients remain in effect.

In addition, CMS did not propose any additional composite APCs nor did it propose any changes related to drug administration. Despite no policy changes, payment rates do shift and hospitals should take note of these payment impacts, says Shah. Finally, CMS says it has not proposed any new quality measures for 2014 or 2015 payment determinations.

Continuing adjustments, enforcement delays
CMS plan to continue the 7.1% OPPS payment adjustment to certain rural sole community hospitals (SCHs), including essential access community hospitals (EACHs). This adjustment would apply to all services paid under the OPPS, excluding separately payable drugs and biologicals, devices paid under the pass-through payment policy, and items paid at charges reduced to cost.

CMS also plans to continue providing additional payments to cancer hospitals so that the hospital's payment-to-cost ratio (PCR) with the payment adjustment is equal to the weighted average PCR for the other OPPS hospitals using the most recent submitted or settled cost report data.

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