Payment Rates Improve Under
Medicare Outpatient Final Rule; No Pro Rata Reduction
November 8, 2002-On Nov. 1, the Centers for Medicare
and Medicaid Services (CMS) published a final
rule in the Federal Register containing the 2003 hospital
payment rates under the Medicare outpatient prospective payment
system (PPS or OPPS) [67 FR 66718]. The proposed rule had
been published Aug. 9 [67 FR 52092].
The OPPS 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.
According to CMS, under the final rule, overall payments
will increase by 3.7 percent in 2003, but that increase varies
by type of hospital. For example, rural hospital outpatient
PPS 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 rule,
APC 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.
Information:
Karen Fisher, Senior Associate Vice President
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Get Washington Highlights
in your Inbox!
| 
