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Hospital Payment and Quality

Each year, the Centers for Medicare & Medicaid Services (CMS) publishes regulations that contain changes to the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Medicare Outpatient Prospective Payment System (OPPS) for hospitals. Regulatory changes affecting Medicare DGME and IME payments often are included in the annual Medicare IPPS regulation. The IPPS and OPPS regulations also address the ongoing hospital quality reporting programs, as well as the implementation and modification of performance-based payment programs legislated under the Affordable Care Act (ACA). These include the Hospital Acquired Condition (HAC) Reduction, Value-Based Purchasing (VBP), and the Hospital Readmission Reduction Programs.

CMS publishes the final IPPS regulation no later than August 1, and the changes are effective at the beginning of the next federal fiscal year (October 1). The final OPPS regulation is issued no later than November 1, and changes take effect at the beginning of the next calendar year (January 1).

FY 2017 and 2018 Medicare Inpatient PPS

In April 2017, CMS released the fiscal year (FY) 2018 IPPS Proposed Rule.

Webinars:

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Previous IPPS Rules

CY 2017 and 2018 Medicare Outpatient PPS

On November 1, 2016, CMS released the calendar year (CY) 2017 OPPS Final Rule.

Webinars:

Previous OPPS Rules