Calendar Year 2003 Medicare
Outpatient Prospective Payment System
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Related Resources
AAMC Documents
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Current Status as of November 6, 2002
On November 1, 2002, the Centers for Medicare and Medicaid
Services (CMS) published the Medicare outpatient prospective
payment system (OPPS) final rule for calendar year 2003 (67
Fed. Reg. 66718). The Association will be preparing a summary
and analysis of the final rule.
Brief Summary
The Medicare OPPS went into effect in August, 2000. The
system affects only hospital, not physician, Medicare payments
in the outpatient setting. Ambulatory payment classification
(APC) groups are the foundation of the OPPS. The APC groups
determine the payment for each outpatient service provided.
Proposed changes to the 2003 OPPS were published in the Federal
Register on August 9, 2002; the AAMC submitted a comment
letter on this proposed
rule.
According to CMS, under the final rule, overall OPPS payments
will increase by 3.7 percent in 2003, but that increase varies
by type of hospital. For example, rural hospital OPPS payments
will increase 6.2 percent compared to only a 2.6 percent rise
for major teaching hospitals. CMS estimates that total OPPS
payments in 2003 will be $18.7 billion, up from $17.7 billion
in 2002.
On an issue of concern to the AAMC, according to the final
rule, payment rates for a number of high-tech outpatient services
will not be as low as originally published in the proposed
rule. In addition, unlike in 2002, there will be no pro rata
reduction associated with the "pass through" payments for
new drugs and devices because spending for these items is
not expected to exceed the spending cap set by Congress.
AAMC Action
The AAMC prepared a summary and analysis of the proposed
rule, submitted a comment letter, and will prepare a summary
and analysis of the final rule.
Final Rule
The final rule, published November 1, 2002, in the Federal
Register, is available in six parts in text formant and Portable
Document Format (PDF)
42 CFR Parts 405 and 419 Medicare Program; Changes to
the Hospital Outpatient Prospective Payment System and Calendar
2003 Payment Rates; and Changes to the Payment Suspension
for Unfiled Cost Reports; Final Rule
- Part I [pp.66717-66766]: Text
/ PDF
- Part II [pp.66767-66816]: Text
/ PDF
- Part III [pp.66817-66866]: Text
/ PDF
- Part IV [pp.66867-66916]: Text
/ PDF
- Part V [pp. 66917-66966]: Text
/ PDF
- Part VI [pp. 66967-67016]: Text
/ PDF
- Part VII [pp. 67017-67046]: Text
/ PDF
Proposed Rule
The proposed rule published August 9, 2002, in the Federal
Register, is available in six parts in text format and Portable
Document Format (PDF)
42 CFR Part 405 et al. Medicare Program; Changes to the
Hospital Outpatient Prospective Payment System and Calendar
Year 2003 Payment Rates; and Changes to Payment Suspension
for Unfiled Cost Reports; Proposed Rule
- Part I [pp. 52091-52140]: Text
/ PDF
- Part II [pp. 52141-52190]: Text
/ PDF
- Part III [pp. 52191-52240]: Text
/ PDF
- Part IV [pp. 52241-52290]: Text
/
PDF
- Part V [pp. 52291-52340]: Text
/ PDF
- Part VI [pp. 52341-52371]: Text
/ PDF
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Contacts
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
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