OPPS
publication date
Revenue Cycle
CMS Moves Forward with Added Prior Authorization Requirements
CMS finalized new procedures that will be subject to prior authorization in 2023.
Revenue Cycle
Payment Rate Increases for 2023 No Help to Hospitals' 'Tremendous Financial Pressures'
CMS released the 2023 OPPS final rule that includes increased Medicare reimbursement and the establishment of a new provider type,...
Revenue Cycle
CMS Proposes Payment Rate Increase, Officially Ends 340B Cuts in OPPS Rule
CMS proposes increasing outpatient hospital payment rates by 2.7% and considers paying average sales price plus 6% for drugs acquired...
Payer
Medicare and its Members Paid Significantly More to Provider-Based Facilities
The Office of Inspector General (OIG) uncovered that the program and beneficiaries could have saved $1.6 billion combined had they...
Revenue Cycle
CMS Rejects Majority of Applicants for Off-campus PBD Status
The 21st Century Cures Act created an additional exception that allowed off-campus PBDs that met certain requirements to continue to...
Strategy
Requirements for Relocating a PBD
A hospital must submit a single per location request to their CMS Regional Office within 120 days of beginning to...
Finance
2021 OPPS Final Rule: CMS Moving Forward with Inpatient-only List Elimination, Prior Authorization Expansion
For more information on the 2021 OPPS final rule, including changes to supervision for therapy services and payment rates, see...
Finance
2021 OPPS Proposed Rule: CMS Looks to Eliminate Inpatient-only List, Increase 340B Payment Cuts
The proposed rule also introduces many new codes and status indicator changes that stakeholders need to carefully review carefully to...
Clinical Care
CMS Eliminates Direct Supervision Requirement for Hospitals
This rule places decisions about supervision in the control of hospitals and physicians involved in patient care and will make...
Finance
'Above the Law'? Judge Criticizes 2020 Rule on Site-Neutral Payments, Lets It Stand
Hospitals had asked the court that vacated the 2019 rule to enforce its decision against the 2020 rule as well....
Finance
Site-Neutral Back Pay: CMS to Give Hospitals More Money for 2019, Carry Fight Into 2020
The administration agreed to comply with a federal judge's order that vacated site-neutral payment provisions of OPPS 2019, but it...
Finance
Site-Neutral Groundhog? Hospitals Urge Judge to Whack 2020 Payment Policy, Too
The government is moving forward with 'the second year of a two-year phase-in,' even though a judge vacated the policy...