Corporate Compliance

Note: Latest CMS transmittal changes OPPS rates - again

Medicare Insider, July 27, 2010

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Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

Last week, we talked about the changes that CMS announced under the Patient Protection and Affordable Care Act (coined ACA) and released in One Time Notification Transmittal 726. Among those, including some wage indices changes, CMS announced that the Outpatient Prospective Payment System (OPPS) market basket update was reduced by the required 0.25 percentage points. This changed the OPPS conversion factor (CF) announced in the OPPS Final Rule, which is used for the full market basket update, from $67.406 to the ACA rate of $67.362. This is for dates of service furnished on or after January 1, 2010.

CMS has since released One Time Notification Transmittal 728 to correct the OPPS conversion factor and the Inpatient Rehabilitation Facility (IRF) outlier threshold. The revised CY2010 conversion factor to be used for the full market basket update is now $67.241. The full market basket update is used by those facilities that meet the requirements of the Hospital Quality Data Reporting Program (HQDRP).  Those that do not meet the reporting requirements will receive a reduced market basket update conversion factor that reduces their payment rates by 2.0%.  Although the recently announced revision may seem minimal, it affects all of the OPPS payments for hospitals during the entire calendar year.

Continue reading Debbie's note at the MedicareMentor Blog.



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