The Centers for Medicare and Medicaid Services (CMS) has proposed a 3.5% increase in payment rates to hospitals for outpatient services in 2003. According to CMS, this would boost aggregate payments to $530 million more than in 2002. Rural hospitals will also see a gain in outpatient rates, with a proposed 7.6% increase.
The data underlying the 2003 proposed rule have been refined significantly from those available in previous years. Payment rates for ambulatory payment classifications (APCs) are now being set using data from claims submitted by hospitals under the Outpatient Prospective Payment System (OPPS), which went into effect in August 2000.
In addition, the agency has developed ways to make use of data from multiple procedure claims. As a result, the percentage of claims used to set relative weights of APCs has nearly doubled, from 42% for 2002 to 82% for 2003.
The proposed rule also contains provisions for a new APC for procedures that use drug-eluting stents, as well as separate payment for observation services for patients with congestive heart failure, chest pains, and asthma who are directly admitted from a physician’s office.
It also outlines the methodology CMS proposes to use to pay for 95 categories of devices and approximately 240 drugs that will no longer be eligible for pass-through payments on January 1, 2003, and amends Medicare payment-suspension regulations to allow the option of a partial suspension when a hospital fails to file a timely and acceptable cost report.
Finally, the agency estimates significantly higher payment for two key preventive screening tests -- mammography and colonoscopy. Final payment rates for these and other services will be set in the final rule. The proposed rule will be published in the August 9 Federal Register, and CMS will accept public comments on the rule until October 7.
By AuntMinnie.com staff writersAugust 7, 2002
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