Calendar Year 2004 Medicare
Outpatient Prospective Payment System Proposed Rule
 |
|
|
Related Resources
AAMC Documents
|
|
Current Status as of October 17, 2003
The Centers for Medicare & Medicaid Services (CMS) Aug.
12 published in the Federal Register [68 FR 47966] a proposed
rule containing changes to the Medicare outpatient prospective
payment system (OPPS) that would be effective for services
provided on or after Jan. 1, 2004. The OPPS governs Medicare
payments for the hospital component of outpatient services;
the physician payment is governed by the Medicare physician
fee schedule. The AAMC submitted comments
on the proposed rule.
Brief Summary
Pursuant to current law, the base OPPS payment rate (known
as the "conversion factor") will be updated by the full increase
in the hospital inpatient market basket, 3.4 percent. The
Aug. 12 rule also proposes a number of changes to specific
ambulatory payment classifications (APCs), which determine
the payment rates for hospital outpatient services assigned
to APCs.
In an area that had been under consideration for several
years, the proposed rule contains national guidelines for
determining the proper code for assigning emergency and clinic
visits. Currently, hospitals are required to have an internal
set of guidelines to determine what level of visit to report
for each patient. The proposed national guidelines are based
on recommendations of an independent panel convened by the
American Hospital Association and the American Health Information
Management Association.
Particularly noteworthy in the proposed rule is the announcement
that, pursuant to legislative mandate, transitional corridor
payments for most hospitals will no longer be available beginning
in 2004. Hospitals were eligible for these additional payments
if the payments they received under the OPPS were less than
the payments they would have received for the same services
under the payment system in effect before the OPPS. Qualifying
cancer and children's hospitals would continue to be eligible
to receive these payments.
Proposed Rule
The proposed rule published August 12, 2003, in the Federal
Register, is available in six parts in text format and Portable
Document Format (PDF)
42 CFR Parts 410 and 419 Medicare Program; Changes to
the Hospital Outpatient Prospective Payment System and Calendar
Year 2004 Payment Rates; Proposed Rule
- Part I [pp. 47965–48248]: Text
/ PDF
This page contains documents in Portable Document Format (PDF).
The Adobe Acrobat® Reader® is required to view PDF documents. Download
Acrobat® Reader®.
Contacts
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
|
