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.
AHA News
- Jan 03, 2012 | CMS makes correction to OPPS, ASC rule
- Nov 01, 2011 | CMS releases final 2012 OPPS and ESRD rules
- Aug 30, 2011 | AHA again urges changes to proposed VBP program
- Nov 02, 2010 | CMS releases final 2011 OPPS, ASC, PFS, HH rules
- Aug 31, 2010 | AHA urges changes to OPPS/ASC proposed rule
- Nov 02, 2009 | CMS releases OPPS and ASC final rule
- Aug 28, 2009 | OPPS, physician fee comment re-submittals due Monday
- Aug 26, 2009 | AHA recommends changes to proposed OPPS, ASC rule
- Aug 24, 2009 | Software glitch affects some OPPS, physician fee comments
- May 08, 2009 | DoD increases TRICARE OPPS adjustment for eligible hospitals
Recent Efforts
- Jan 04, 2013 | AHA to MedPAC Re: Payment Recommendations for FY 2014
- Dec 06, 2012 | Medicare Outpatient PPS and ASC Final Rule for CY 2013
- Nov 30, 2012 | Hospitals Need to Weigh-in on Supervision Policy for Outpatient Therapeutic Services
- Nov 02, 2012 | CMS Releases Two Final Rules for CY2013: Hospital Outpatient/ASC Payment System and Physician Fee Schedule
- Sep 27, 2012 | Weigh In on Proposed Supervisions Levels for Outpatient Therapeutic Services
- Aug 29, 2012 | AHA Comments to CMS Re: Proposed Rule for CY 2013 Hospital OPPS and ACS PPS
- Jul 26, 2012 | Medicare Outpatient PPS and ASC Proposed Rule for CY 2013
- Jul 09, 2012 | CMS Releases Three Proposed Rules for CY 2013: Hospital Outpatient/ASC Payment System, Physician Fee Schedule, and Home Health PPS
- Jun 27, 2012 | Hospitals Need to Weigh-In on Supervision Policy for Outpatient Therapeutic Services
- Dec 13, 2011 | Medicare Outpatient PPS and ASC Final Rule for CY 2012
Highlighted Resources
Factsheet: Outpatient Evaluation & Management Services
Detailed Summary of OPPS/ASC Final Rule for CY 2013, Prepared by Health Policy Alternatives, November 19, 2012 
AHA Comment Letter to CMS Re: Proposed Rule for CY 2013 Hospital OPPS and ACS PPS and Quality Reporting Programs, August 29, 2012
Factsheet: Supervision of Hospital Outpatient Therapeutic Services