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New Rates, New Policies in 2011 OPPS/ASC Proposed Rule

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  • In CMS
  • July 7, 2010
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The 2011 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) payment system proposed rule, released July 2 by the Centers for Medicare & Medicaid Services (CMS), proposes payment system changes and 2011 payment rates. The proposed rule also would implement several health care reform law provisions, including some pertaining to certain inpatient hospital services, graduate medical education costs, and physician self-referral rates, which did not make it into the 2011 Inpatient Prospective Payment System (IPPS) proposed rule, published May 4.Overall, CMS estimates that providers would receive a 2.2 percent payment increase in 2011 under the proposed rule. A proposed hospital outpatient department (OPD) fee schedule update factor increase of 2.15 percent for 2011, in addition to a required proposed wage index budget neutrality adjustment of approximately 1.0011, a proposed cancer hospital budget neutrality adjustment of 0.9934, and a proposed adjustment of 0.06 percent of projected OPPS spending for the difference in the pass-through spending would result in a proposed conversion factor for 2011 of $68.267. For those hospitals that fail to meet the Hospital Outpatient Quality Data Reporting (HOP QDRP) requirements, the proposed reduced conversion factor for 2011 would be $66.930.
Changes in the proposed rule would affect all classes of hospitals and community mental health centers (CMHCs). CMS estimates all classes of hospitals would experience positive updates in OPPS payments in 2011 to varying degrees with the exception of CMHCs, which would see an overall decrease in payment of 41.7 percent due to the recalibration of payment rates for partial hospitalization services. Specifically, dedicated cancer hospitals would experience an aggregate payment increase of 40.5 percent.
The changes and payment rates in this proposed rule apply to providers paid under the OPPS/IPPS and not to those paid under other fee schedules, including ambulance, physical and occupational therapy, speech-language pathology services, screening and diagnostic mammography and, effective Jan. 1, 2011, annual wellness visits.
The 2011 OPPS/ASC proposed rule (CMS-1504-P) will appear in the Aug. 3 Federal Register with comments accepted until Aug. 31, 5 pm EST.
CMS also released two related documents, one with corrections to 2010 OPPS and ASC payments and a second document containing a notice of the final payment rates and addenda for the 2010 OPPS and ASC payment system.

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