CMS issues final 2008 payment rules
for hospital outpatient, ASC services
The federal Centers for Medicare and Medicaid Services (CMS) issued final rules Nov. 1 updating hospital Outpatient Prospective Payment System (OPPS) rates and ambulatory surgery center (ASC) payment rates for services to be performed in calendar year 2008.
Taking into account the annual market basket update (an inflation adjuster for hospitals’ costs of providing services), CMS estimated that hospitals would receive an overall average 3.8% increase in Medicare payments for outpatient services next year. In a news release issued the same day, CMS noted that Medicare spending on hospital outpatient services has been growing significantly in recent years, helping fuel the rapid growth in Medicare Part B spending. The agency estimated that, collectively, CMS and Medicare beneficiary coinsurance payments under the OPPS system will increase 10% to about $36 billion in 2008.
CMS’ final rule on ASC payment rates for 2008 largely tracked the sweeping reform proposals the agency first outlined last August. ASCs generally will be paid 65% of the Hospital Outpatient Department rates, and 819 new procedures will be added to the list eligible for reimbursement by Medicare, according to a member alert quickly posted to the Web site of ASC industry group FASA. CMS also stuck to its proposal to phase in the new ASC payment system over a four-year-period for services that previously had been eligible for Medicare reimbursements. New procedures added to the ASC eligibility list will come under the new payment system immediately in 2008. Additional analysis of the final ASC payments rule is available on FASA’s Web site.
In the agency’s news release, CMS acting Administrator Kerry Weems said, “The policies of the revised ASC payment system that are reflected in the 2008 payment rates further expand beneficiary choices by providing patients the flexibility to select, in consultation with their physicians, the most appropriate care setting for their particular surgical needs. The revised system takes a major step toward eliminating financial incentives for choosing one setting over another, thereby placing patients’ needs first, increasing efficiencies and leading to savings for both beneficiaries and the Medicare program.”
