Final Rule for CY 2019 Hospital Outpatient and ASC Prospective Payment Systems

The Centers for Medicare and Medicaid Services (CMS) have issued a rule that updates payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and in ambulatory surgical centers (ASCs) beginning Jan. 1, 2019 (CY 2019). The rule includes site-neutral payment policies and changes to the 340B Drug Pricing Program. CMS is increasing the OPPS rates by 1.35 percent in 2019. The agency arrived at the rate increase through the following updates: a positive 2.9 percent market basket update, a negative 0.8 percentage point update for a productivity adjustment and a negative 0.75 percentage point adjustment for cuts under the Affordable Care Act. CMS is making payments for clinic visits site-neutral by reducing the payment rate for hospital outpatient clinic visits provided at off-campus provider-based departments by 60 percent. Based on a two-year phase-in of this policy, half of the total reduction will apply in 2019. The clinic visit is the most common service billed under the OPPS, and CMS estimates this change will save the Medicare program and beneficiaries a combined $380 million in 2019. For more details, see today’s first Financial Feature.

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