CMS Fact Sheet: Final 2010 Policy, Payment Changes for OPPS and ASCs

FINAL 2010 POLICY, PAYMENT CHANGES FOR HOSPITAL OUTPATIENT DEPARTMENTS AND AMBULATORY SURGICAL CENTERS

Excerpts:

OVERVIEW

On Oct. 30, 2009, the Centers for Medicare & Medicaid Services (CMS ) issued a final rule with comment period that updates payment policies and rates for both hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) for calendar year (CY) 2010.  The update to ASC rates constitutes the third year of a four-year transition to a revised payment system that aligns ASC payment rates with those paid to HOPDs for similar services.    The final rule with comment period also seeks to promote higher quality, efficient services for Medicare beneficiaries by adopting improvements to the Hospital Outpatient Quality Data Reporting Program (HOP QDRP) and establishing procedures to make the data collected through the HOP QDRP publicly available.

FOR HOSPITAL OUTPATIENT DEPARTMENTS

Significant Changes For Calendar Year 2010

Implementing New Coverage Authorized by MIPPA

• Kidney disease education

• Pulmonary and cardiac rehabilitation

Strengthening Ties between Payment and Quality:

• Payment reduction for failure to report quality measures
  

• Quality measures to be reported
  

• Validation of quality reporting

• Public reporting of quality data

Supervision of Hospital Outpatient Services:

• Supervision requirements for outpatient services

Payment for Drugs, Biologicals, and Radiopharmaceuticals:

• Drugs and pharmacy overhead
  

• Pass-through implantable biologicals

• Drug and biological pass-through payment eligibility period

• Therapeutic radiopharmaceuticals
  

Payment for Brachytherapy Sources

Partial Hospitalization Services, including Services Provided by CMHCs

FOR AMBULATORY SURGICAL CENTERS

Significant Changes For Calendar Year 2010:

ASC Payment Rate Updates

Changes to ASC Covered Surgical Procedures and Covered Ancillary Services

Links for the Final Rules:

Hospital Outpatient PPS

ASC Payment