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Showing posts with the label OPPS Final Rule

CY 2026 OPPS proposed rule: Key updates for hospitals, ASCs and providers

On July 15, the Centers for Medicare & Medicaid Services (CMS) released the CY 2026 Proposed Rule for the Medicare Outpatient Prospective Payment System (OPPS). The proposed rule introduces several significant policy changes that will impact hospitals and ambulatory surgical centers (ASCs) beginning Jan. 1.  From updates to the 340B payment policy and ambulatory payment classifications (APCs) to the elimination of the Inpatient-only (IPO) list and expanded reporting requirements, the CY 2026 OPPS rule is one of the most comprehensive updates in recent years.   CMS projects an overall $1.61 billion increase in OPPS payments before accounting for the 340B remedy offset, which is expected to reduce payments by $1.1 billion, resulting in a net increase of approximately $510 million.  This blog post breaks down the most important proposed changes, financial impacts and reporting requirements so your organization can prepare for compliance and optimize reimbursement strateg...

CMS finalizes 2024 OPPS final rule: 4 must-know updates

On Nov. 2, CMS finalized the calendar year 2024 Medicare Outpatient Prospective Payment System final rule . The 2024 OPPS final rule includes policies that will: add 10 services to the Inpatient Only list; establish an intensive outpatient program; expand the partial hospitalization program rate structure; update payment rates and policies for ambulatory surgical centers; update the requirements for the Hospital Outpatient Quality Reporting Program; outline quality program requirements for Rural Emergency Hospitals; and standardize the reporting of standard chart data using a CMS template. Read on to learn essential OPPS final rule information, important details and dates. We’ll also reveal how you can register for DataGen’s upcoming client exclusive OPPS rule analysis webinar . 4 key CMS 2024 OPPS final rule components 1. Expanded and updated rates CMS estimates a 2.1% rate increase for CY 2024, which represents a $6 billion increase in outpatient payments compared to the CY 2023 OPPS...