Send Up a Cheer for Outpatient Payment Increase

Comment on OPPS 2004 proposed rule by Oct. 6

If you think a 3.8 percent payment increase sounds appealing, you're in luck - CMS thinks so too. According to the agency's outpatient prospective payment system (OPPS) proposed rule released Aug. 6, reimbursement for outpatient services would rise nearly 4 percent by Jan. 1. One change in OPPS policy, however, could prove tricky this year. CMS proposed creating separate ambulatory payment classifications for drugs and biologicals with median costs at or above $150, basing reimbursement on hospital cost data. The agency admits that this change "would result in a significant decrease in payments to the hospital, compared to 2003 payment levels" for certain products.
 
 Other highlights of the rule include:
  removing eight drugs and biologicals and two device categories from the pass-through list
  changing payment rules for "orphan drugs"
  revamping new-technology APCs
  setting the outlier threshold at 2.75 times the APC payment rate
  establishing a new outlier threshold for community mental-health centers
  establishing a process for hospitals to comment on potential changes to the way emergency department and clinic visits are coded.
     To see the proposed rule, go to http://cms.hhs.gov/regulations/hopps/2004p/changecy2004.asp.

- Published on 2003-09-11