On Wednesday, July 25, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining changes to the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for potential implementation in 2019.

The proposed changes to the two programs are intended to further advance CMS’s priority to achieve greater price transparency and interoperability, and to reduce burden so hospitals and ambulatory surgical centers can operate with increased flexibility. CMS is moving toward the goal of creating a patient-centered health care system to allow patients to become more active health care consumers.

Highlights of the proposed changes include:

  • Reducing payment differences between sites of service so patients can benefit from high quality care at lower costs
  • Exercising authority under the law to control unnecessary increases in the volume of covered hospital outpatient department services
  • Paying services assigned to New Technology Ambulatory Payment Classifications (APCs) with fewer than 100 claims annually under one of several alternative payment methodologies
  • Lowering the device threshold to 30 percent
  • Increasing OPPS payment rates by 1.25 percent, in accordance with Medicare law
  • Paying for services in new clinical families of services furnished at excepted off-campus provider-based departments (PBDs) under the PFS instead of the OPPS

CMS is also seeking comment on many components of the proposals and has included three requests for information (RFIs) in the rule, regarding price transparency, advancing My HealthEData, and a potential model to leverage the authority under the Competitive Acquisition Program for Part B drugs and biologicals.

Download the proposed rule and learn more about the proposed changes by viewing the Proposed Rule Fact Sheet. The AASM is reviewing the rule to determine the potential impact of the proposed changes. Comments to the proposed rule must be submitted by 5 p.m. on Sept. 24.

Get more coding and reimbursement information from the AASM.