On October 30, 2009, the Centers for Medicare & Medicaid Services (CMS) released a display copy of a Final Rule (with comment period) that updates the Medicare payment policies and rates for both hospital outpatient departments and ambulatory surgical centers (ASC) for calendar year (CY) 2010.
In brief, some highlights of the Final Rule include:
Hospital Outpatient Prospective Payment System. CMS estimates that the aggregate Medicare payments to providers under the hospital outpatient prospective payment system (OPPS) in CY 2010 will be $32.2 billion, which is an $1.9 billion increase over CY 2009.
- Inflation Update. Hospitals will receive an annual inflation update of 2.1 percent for CY 2010.
- Payment Reduction/Quality Data Reporting. The 2.1 percent update will be reduced by 2 percentage points for most services furnished by hospitals that failed to meet the CY 2009 reporting requirements of the Hospital Outpatient Quality Data Reporting Program (HOP-QDRP).
- Quality Measures. CMS will continue to require hospitals subject to HOP-QDRP to provide quality data for the current 7 chart-abstracted emergency department and surgical care measures and 4 claims-based imaging efficiency measures for CY 2011 payment determinations.
- Quality Reporting Validation. CMS will implement an HOP-QDRP validation requirement to ensure that hospitals are accurately reporting measures using chart-abstracted data. According to CMS, the validation results will not affect a hospital's CY 2011 OPPS payment.
- Public Quality Data Reporting. CMS is establishing procedures to make HOP-QDRP quality measure data publicly available as early as June 2010.
- Supervision of Outpatient Services. In CY 2010, CMS will allow certain nonphysician practitioners (i.e., physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and licensed clinical social workers) to provide direct supervision for all hospital outpatient therapeutic services that they are authorized to personally perform according to state scope of practice rules and hospital granted privileges. In the Final Rule, CMS addresses "direct supervision" in the context of on-campus hospital outpatient therapeutic services and services furnished in an off-campus provider based department.
Ambulatory Surgical Centers. According to CMS, aggregate Medicare payments to ASCs is expected to total $3.4 billion in CY 2010.
- Inflation Update. ASCs will receive a 1.2 percent inflation update in CY 2010.
- ASC Covered Procedures/Services. CMS will add 26 surgical procedures to the list of procedures that the Medicare program will pay for when performed in an ASC. CMS also newly designates 6 procedures as office based procedures and temporarily designates an additional 16 procedures as office based procedures based on coding changes for CY 2010.
The Final Rule is scheduled to appear in the Federal Register on November 20, 2009. CMS reports that comments on designated provisions will be due by 5:00 p.m. (ET) on December 29, 2009.
For more information on the Final Rule, see the following CMS documents:
- Press Release: CMS Adopts Policy, Payment Rate Changes for Services in Hospital Outpatient Departments
- Fact Sheet: Final 2010 Policy, Payment Changes for Hospital Outpatient Departments and Ambulatory Surgical Centers
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