CMS Publishes FY 2013 Hospital OPPS and ASC Final Rule

Date posted: November 1, 2012

The Centers for Medicare & Medicaid Services (CMS) recently released the finalized Hospital Outpatient and Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rule. CMS updated Medicare payment policies and rates for hospital outpatient and ASC services for the 2013 calendar year (CY).

The 2013 OPPS and ASC final rule outlined changes to the Quality Improvement Organization (QIO) program regulations, aiming to streamline QIOs’ operations, increase their transparency, and improve communication between QIOs and beneficiaries. CMS clarified its policy from the CY 2012 OPPS and ASC final rule regarding the supervision of outpatient therapy services in Critical Access Hospitals (CAHs) and OPPS hospitals. Furthermore, CMS extended non-enforcement instruction of the supervision rules for one additional year. Although CMS did not adopt new measures for the Hospital Outpatient Quality Reporting Program, the agency finalized the automatic retention of program measures established in the previous payment determinations for subsequent year payment determinations.

The final rule will take effect on January 1, 2013.

The OPPS/ASC final rule is available at: http://www.gpo.gov/fdsys/pkg/FR-2012-11-15/pdf/2012-26902.pdf.

Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Electronic Reporting Pilot; Inpatient Rehabilitation Facilities Quality Reporting Program; Revision to Quality Improvement Organization Regulations; Final Rule, 77 Fed. Reg. 221, 68210, 68565 (Nov. 15, 2012).

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