CMS proposes significant Medicare OPPS and ASC payment system changes for 2019

On July 25, 2018, the Centers for Medicare & Medicaid Services published its 2019 Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule.  A fact sheet describing the proposed rule is available here. The proposed rule can be accessed here. CMS proposes to update hospital OPPS payment rates by 1.25 percent and update ASC payment rates using the hospital market basket rather than the consumer price index-urban (CPI-U) for 2019-2023.  CMS proposes significant changes to certain OPPS payments, including (i) applying a Medicare Physician Fee Schedule (MPFS) equivalent payment rate for clinic visits paid under the OPPS when performed in hospital off-campus provider-based departments (PBDs); and (ii) paying for services in new clinical families of services provided in hospital excepted off-campus PBDs under the MPFS rather than the OPPS.           The…

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