Outpatient Prospective Payment System
Section 4523 of the Balanced Budget Act of 1997 (BBA) provides authority for CMS to implement a prospective payment system (PPS) under Medicare for hospital outpatient services, certain Part B services furnished to hospital inpatients who have no Part A coverage, and partial hospitalization services furnished by hospitals and community mental health centers. The provisions of this section were further modified by sections 201 and 202 of the Balanced Budget Refinement Act of 1999 (BBRA) and subsequent legislation.
The outpatient prospective payment system (OPPS) significantly changes how hospitals are reimbursed for outpatient services under Medicare - affecting communications, coding procedures, patient records, billing, and reimbursement. Hospitals require new strategies for the effective management of outpatient information, resources, and services.
- Aug 27, 2015 | AHA supports proposed two-midnight changes; opposes OPPS conversion factor cut
- Jul 1, 2015 | CMS releases OPPS, ASC proposed rule with changes to two-midnight policy
- Oct 8, 2014 | OIG recommends changing how CAH outpatient coinsurance is calculated
- Sep 2, 2014 | AHA submits comments on proposed OPPS rule for CY 2015
- Jul 7, 2014 | CMS releases CY 2015 OPPS, ASC proposed rule
- Apr 17, 2014 | OIG recommends site-neutral policy for certain OPPS, ASC payments
- Mar 12, 2014 | CMS advised to reduce supervision level for 18 outpatient therapeutic services
- Sep 13, 2013 | AHA: Outpatient payment proposals need more analysis, validation
- Sep 6, 2013 | AHA urges CMS to extend direct supervision enforcement moratorium
- Sep 5, 2013 | Comment period extended for certain portions of OPPS/ASC proposed rule
- Aug 27, 2015 | AHA Comments to CMS Re: Outpatient PPS-ASC Proposed Rule for CY 2016
- Aug 04, 2015 | Urge Your Representative to Cosign Letter Urging CMS to Provide a Positive Outpatient Update
- Jul 20, 2015 | Medicare Outpatient PPS and ASC Proposed Rule for CY 2016
- Jul 02, 2015 | CMS Releases Two Proposed Rules for CY 2016
- Nov 21, 2014 | Medicare Outpatient PPS and ASC Final Rule for CY 2015
- Nov 03, 2014 | CMS Releases Three Final Rules For CY 2015
- Jul 25, 2014 | Medicare Outpatient PPS and ASC Proposed Rule for CY 2015
- Jul 07, 2014 | CMS Releases Three Proposed Rules for CY 2015: Hospital Outpatient/ASC Payment System, Physician...
- Dec 19, 2013 | Medicare Outpatient PPS and ASC Final Rule for CY 2014
- Dec 02, 2013 | CMS Releases Two Final Rules For CY 2014: Hospital Outpatient/ASC Prospective Payment System And Physician Fee Schedule