• E-mail
• Print
• RSS

CMS announced payment rate changes for outpatient services in 2006

Patient Financial Services Weekly Advisor, November 4, 2005

A final Outpatient Prospective Payment System (OPPS) rule states that acute care hospitals will receive a 3.7% inflation update in Medicare payment rates for outpatient services in 2006, the Centers for Medicare & Medicaid Services announced on Wednesday.

The rule will also lower coinsurance rates that Medicare patients have to pay for outpatient services.

About 400 sole community hospitals will receive an additional 7.1% payment adjustment.

"Today's final rule underscores Medicare's ongoing commitment to improving beneficiary access to quality outpatient services regardless of where they live," said CMS Administrator Mark B. McClellan, MD, PhD.

Prior to the OPPS in August 2000, the Medicare patient often paid more than 50% of the hospital bill.

Under the rule, the coinsurance rate for 31 additional medical and surgical Ambulatory Payment Classifications (APCs) will decline to the 20% minimum.

The rule also reduces the maximum coinsurance rate for any service to 40% of the hospital bill for APCs in 2006, which is down from 45% in 2005.

Overall, the average beneficiary copayments for all outpatient services are expected to drop from 33% to 29%.

• E-mail to a Colleague
• Print
• RSS
• Archive