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2019 Hospital OPPS Proposed Rule

On July 25, the CMS released proposed changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for 2019.

Key proposals include:

  • Increasing the OPPS payment rates by a factor of 1.25% and to increase ASC rates by 2.0%.
  • Applying a Physician Fee Schedule-equivalent payment rate for clinic visits provided at all off-campus provider-based department (PBD) that is paid under OPPS. This proposal would reduce the OPPS payment rate for the clinic visit (HCPCS code G0463) to $46 (from $116).
  • Revising the ASC definition of “surgery” for CY 2019 to account for “surgery-like” procedures, specifically adding some cardiovascular codes (including 12 cardiac catheterization procedures) to the covered procedures list.

The Proposed Rule also includes proposed changes and Requests for Information (RFI) in areas such as price transparency, quality reporting, the Competitive Acquisition Program, among others. The CMS fact sheet is available at the link below. Comments are due no later than September 24, 2018.

CMS.gov 2018-Fact-sheets items

If you have questions or would like to discuss, please contact Scott Treida at 317-713-7950 or streida@blueandco.com.

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