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November 4, 2011

CMS Adopts Outpatient Care Changes

This week the Centers for Medicare & Medicaid Services (CMS) issued a final rule that will update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning Jan. 1, 2012. In addition to establishing payment rates for calendar year (CY) 2012, the final rule expands the measures to be reported under the Hospital Outpatient Quality Reporting Program, creates a new quality reporting program for ASCs, and strengthens the Hospital Value-based Purchasing (Hospital VBP) program that will affect payments to hospitals for inpatient stays beginning Oct. 1 2012.

The final rule also establishes an electronic reporting pilot that will allow additional hospitals, including critical access hospitals (CAHs), to report clinical quality measures in CY 2012 for purposes of participating in the Medicare Electronic Health Record Incentive Program. The final rule with comment period for the OPPS and the ASC payment system can be downloaded from this site. A CMS fact sheet providing more details on the final rule can be found here.