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Hospitals will get a 2.3% payment hike for outpatient services effective Jan. 1, 2002, under a proposed rule for the outpatient prospective payment system (OPPS) released in late August by the Centers for Medicare and Medicaid Services (CMS).
The rule would achieve the goal of making appropriate reimbursement payments given the ongoing shift of services from inpatient to outpatient setting, according to Tom Scully, CMS administrator.
While the rule outlines possible approaches for CMS in estimating payments for hospitals’ use of "pass-through" devices, drugs, and biological products in outpatient services, it makes no actual estimate. Congress required Medicare to temporarily make such payments and capped them at 2.5% of the estimated overall amount paid under OPPS.
The OPPS establishes base payment rates based on groups of services, known as ambulatory payment classifications, that are clinically similar and require comparable resources. Before the implementation of OPPS, hospitals were paid for outpatient services based on costs.
Currently, should the estimate exceed the cap, an across-the-board cut on all pass-through payments would be required. The proposed rule, published in the Aug. 24 Federal Register, can be viewed at the CMS web site, www.hcfa.gov. CMS will accept public comments on the rule and publish a final rule later in the fall. t