[Source: Healthcare Financial Management Association (HFMA)]
CMS Issues 2008 Outpatient Prospective Payment System Final Rule
On Nov. 1, the Centers for Medicare and Medicaid Services (CMS) continued its initiative to link payment with quality in a final rule with comment period updating the hospital Outpatient Prospective Payment System (OPPS), effective for services furnished during CY08. The rule also updates the payment rates for the revised ambulatory surgical center (ASC) payment system beginning in CY08.
After taking into account the market basket update and other factors that affect the level of payments, CMS estimates hospitals will receive an overall average increase of 3.8 percent in Medicare payments for outpatient services in CY08. The CMS Office of the Actuary projects that payments (including beneficiary coinsurance) under the OPPS will increase by about 10 percent to approximately $36 billion in CY 2008 from $32.7 billion in CY 2007, due in part to increased use of hospital outpatient services.
Hospitals that are paid under the Inpatient Prospective Payment System are required to report the applicable hospital outpatient quality measures in order to receive the full OPPS market basket update in CY 2009; otherwise, their CY 2009 update will be reduced by 2.0 percentage points.
In addition, the final rule provides larger payment bundles for certain OPPS services, which is intended to provide hospitals with greater flexibility in managing their resources.
The final rule will be published in the Federal Register on Nov. 27, 2007. View the final rule. Read the CMS press release.
See AHLA's report on this issue: "Final OPPS Rule Includes Overall 3.8% Update", Health Lawyers Weekly, November 2, 2007
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Medicare Final Rule Announces 2008 Physician Fees and Reforms for Accurate Payments and Quality
Under a final physician payment rule issued yesterday, the Centers for Medicare and Medicaid Services (CMS) estimates that it will pay approximately $58.9 billion to about 900,000 physicians and other healthcare professionals. The revised payments, quality incentive rates, and related policy changes, which will become effective Jan. 1, 2008, are included in the Medicare physician fee schedule final rule. The rule will be published in the Nov. 27 Federal Register.
Since July 1, 2007, under the Physician Quality Reporting Initiative (PQRI), eligible professionals who report specific measures on quality of care furnished to Medicare beneficiaries may earn incentives up to 1.5 percent of their total allowed charges, subject to a cap.
The Medicare law includes a statutory formula requiring CMS to implement a negative 10.1 percent update in payment rates for physician-related services. This formula compares the actual rate of growth in spending to a target rate, which is based on such factors as the growth in the number of Medicare fee-for-service beneficiaries and statutory or regulatory changes in benefits. According to a press release, "CMS has no choice but to implement this negative update because it is mandated by a statutory formula."
Download the final rule. Read the CMS press release.
See AHLA's report on this issue: "CMS Issues Final Physician Payment Rule With 10.1% Cut", Health Lawyers Weekly, November 2, 2007
