Medicare Outpatient Proposed
Rule Published
August 15, 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.
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.
Comments on the proposed rule are due by Oct. 6 with a final
rule scheduled to be published in the late fall.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Get Washington Highlights
in your Inbox!
| 
