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The Hospital OQR Program is a pay-for-reporting quality program for the hospital outpatient department setting. CMS Proposes Rule to Advance Health Equity, Improve Access to Care, and Promote Competition and Transparency, CY 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1753FC), CMS OPPS/ASC Final Rule Increases Price Transparency, Patient Safety and Access to Quality Care, CY 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS-1753-P), CMS Proposes Rule to Increase Price Transparency, Access to Care, Safety & Health Equity. CMS and the nations hospitals work collaboratively to publicly report hospital quality performance information on the Care Compare website located at www.medicare.gov/care-compare/ and the Provider Data Catalog on data.cms.gov. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The ASCQR Program requires ASCs to meet program requirements or receive a reduction of 2.0 percentage points in their annual fee schedule update. If CMS determines that a surgical procedure meets the requirements to be added to the ASC CPL, including a surgical procedure nominated by an external party, it would propose to add the surgical procedure to the ASC CPL for January 1, 2023. OPPS Transitional Payment for Drug and Biological Pass-Through and Transitional Payment for Device Pass-Through. CMS developed this methodology with the input of a broad array of stakeholders to summarize the results of many measures currently publicly reported. 20-1114, 2022 WL 2135490). CMS is proposing to maintain the existing rate structure, with a single PHP Ambulatory Payment Classification (APC) for each provider type, for days with three or more services per day. CMS is also proposing to align Hospital OQR Program patient encounter quarters for chart-abstracted measures to the calendar year for annual payment update (APU) determinations, and add a targeting criterion in the selection of hospitals for data validation, for hospitals withfewer than four quarters of data subject to validation, due to receiving an extraordinary circumstance exception for one or more quarters. Heres how you know. Ordinarily, the best available claims data is the most recent set of data, which would be from two years prior to the calendar year that is the subject of rulemaking. The Centers for Medicare & Medicaid Services (CMS) Nov. 1 posted its calendar year (CY) 2023 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule. In response, this year CMS released data for the first time on hospital and skilled nursing facility mergers, acquisitions, consolidations, and changes in ownership going back to 2016, and will update the data quarterly going forward. On July 27, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1783-F) to update Medicare payment policies and rates for the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for fiscal year (FY) 2024. The CY 2022 OPPS/ASC final rule updates Medicare payment rates for Partial Hospitalization Program (PHP) services furnished in hospital outpatient departments and Community Mental Health Centers (CMHCs). For CY 2022, CMS is modifying its current policy to provide for separate payment for non-opioid pain management drugs and biologicals that function as surgical supplies in the ASC setting when those products meet certain criteria finalized in this rule. Secure .gov websites use HTTPSA The law requires that the Secretary must review payments under the OPPS and ASC for opioids, and evidence-based non-opioid alternatives for pain management, to ensure there are not financial incentives to use opioids instead of non-opioid alternatives. This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year (CY) 2022 based on our continuing experience with these systems. https:// Beneficiaries will not be charged coinsurance on the additional 5% payment. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Hospital Outpatient Prospective Payment System: Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022, On December 28, 2022, the FDA revised the, CMS created HCPCS code C9507 for COVID-19 convalescent plasma for use in the outpatient setting, effective on or after December 28, 2022. Yesterday, federal officials introduced two sets of proposed rules, which included possible revisions to the Medicare Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) for the 2024 calendar year. CMS is also seeking comment on measures and topics for future considerations, including reimplementation of the ASC Volume on Selected ASC Surgical Procedures (ASC7) measure or adoption of another volume indicator as a quality measure, a specialty center approach for ASC quality measures, and interoperability and EHR use in the ASCQR Program. In the CY 2021 OPPS/ASC final rule, CMS established a policy in which procedures removed from the IPO list beginning January 1, 2021 would be indefinitely exempted from certain medical review activities related to the two-midnight policy. The ASCQR Program is a pay-for-reporting quality program for the ASC setting. Federal government websites often end in .gov or .mil. (CY) 2024 proposed policies and payments for the Outpatient Prospective Payment System (OPPS), Ambulatory Surgical Center (ASC), and Physician Fee Schedule (PFS). Prohibiting Additional Specific Barriers to Access to the Machine-Readable File: CMS is updating the regulations prohibition of certain activities that present barriers to access to the machine-readable file, specifically requiring that the machine-readable file be accessible to automated searches and direct downloads. Track Three would be for all other RO participants and would not be a MIPS APM or Advanced APM. On December 28, 2022, the FDA revised theemergency use authorizationfor COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies. Hospital Outpatient PPS | CMS The Hospital OQR Program is a pay-for-reporting quality program for the hospital outpatient department setting. In the CY 2018 OPPS/ASC final rule with comment period, CMS reexamined the appropriateness of paying the average sales price (ASP) plus 6% for drugs acquired through the 340B Program, given that 340B hospitals acquire these drugs at steep discounts. You can decide how often to receive updates. In the CY 2023 OPPS/ASC proposed rule, CMS is proposing to update the Cataracts: Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery (OP-31) measure to be voluntary due to ongoing COVID-19 public health emergency (PHE). These retroactive corrections typically occur on a quarterly basis as a part of the OPPS payment system quarterly update change request. Medicare Program: Hospital Outpatient Prospective Payment and MLN6922507 - Medicare Payment Systems - June 2023 This includes, using the equitable adjustment authority under section 1833(t)(2)(E), since, The Radiation Oncology (RO) Model is designed to test whether making payments to. Hospital Outpatient Prospective Payment System The PFS-equivalent payment rate is approximately 40% of the OPPS payment rate, and the clinic visit is the most frequently billed service under the OPPS. CMS is also proposing that audio-only interactive telecommunications systems may be used to furnish these services in instances where the beneficiary is unable to use, does not wish to use, or does not have access to two-way, audio/video technology. Outpatient Prospective Payment System | ACS - The American College of Use of CY 2019 Claims Data for CY 2022 OPPS and ASC Payment System Ratesetting Due to the PHE. (Additional information regarding these requirements is included in the proposed rules preamble as well as in future sub-regulatory guidance.) As CMS considers future reporting on the Safe Use of Opioids eCQM, CMS sought comments in the CY 2022 OPPS/ASC proposed rule on the appropriateness of maintaining this previously finalized policy or instead proposing in future rulemaking to allow hospitals to self-select the Safe Use of Opioids eCQM from the finalized set of eCQMs. The Radiation Oncology (RO) Model is designed to test whether making payments to hospital outpatient departments and physician group practices (including freestanding radiation therapy centers) for radiotherapy (RT) services that do not vary based on care setting or how much or what type of care is delivered over time, preserves or enhances the quality of care furnished to Medicare beneficiaries while reducing Medicare spending. Final In addition to proposing payment rates, this years rule includes proposals that align with several key goals of the Administration, including advancing health equity in rural areas, promoting competition in the health care system, and promoting safe, effective, and patient-centered care. Beginning January 1, 2018, Medicare adopted a policy to pay an adjusted amount of ASP minus 22.5 percent for certain separately payable drugs or biologicals acquired through the 340B Program. PDF CY 2023 Hospital Outpatient Prospective Payment System (HOPPS) Final As a result, CMS is proposing to use CY 2021 claims data with cost report data through CY 2019 (prior to the PHE) to set CY 2023 OPPS and ASC payment system rates. Information about CMS' Medicare Outpatient Prospective Payment System (OPPS). Rural Sole Community Hospital Exemption to the Clinic Visit Payment Policy. We are also concerned about the potential for bias in algorithms and predictive modeling, and are seeking comments on how we could encourage software developers to prevent or mitigate the possibility of bias in new applications of this technology. Access the below OPPS related information from this page. E1 Not paid by Medicare when submitted on outpatient claims (any outpatient bill type). Only the hospital outpatient departments that are participating in the Pennsylvania Rural Health Model (PARHM) will be excluded from the RO Model rather than all HOPDs eligible to participate in PARHM; For more information on the RO Model, visit: https://innovation.cms.gov/initiatives/radiation-, The ASCQR Program is a pay-for-reporting quality program for the ASC setting. The three codes that were proposed for removal and are being retained are CPT codes 0499T, 54650, and 60512. For comments and feedback on the application of these principles to the Hospital OQR Program Outpatient, ASC, and REH Quality Reporting Programs, readers can respond to this proposed rule. Elizabeth Bowden MSN MBA RN CPHQ CPPS' Post - LinkedIn The CMS created HOPPS to reduce beneficiary copayments in response to rapidly growing Medicare expenditures for outpatient services and large copayments being made by Medicare beneficiaries.