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Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality
Abstract:
This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2018 to implement changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
Insights
This final rule updates Medicare
Area of Science:
- Health Policy and Economics
- Healthcare Administration
- Medicare Reimbursement Systems
Background:
- The Medicare hospital outpatient prospective payment system (OPPS) and Ambulatory Surgical Center (ASC) payment system require regular updates.
- Experience with existing systems necessitates adjustments to payment rates and reporting requirements.
Purpose of the Study:
- To revise the Medicare hospital outpatient prospective payment system (OPPS) and ASC payment system for Calendar Year (CY) 2018.
- To detail changes in payment rates and factors for Medicare services under OPPS and ASC.
- To update and refine quality reporting programs for hospitals and ASCs.
Main Methods:
- Implementation of a final rule with comment period.
- Analysis of continuing experience with OPPS and ASC payment systems.
- Revision of payment rate calculations and quality reporting program requirements.
Main Results:
- Adjustments to payment rates and factors for Medicare services under OPPS and ASC for CY 2018.
- Updates to the Hospital Outpatient Quality Reporting (OQR) Program requirements.
- Refinements to the ASC Quality Reporting (ASCQR) Program requirements.
Conclusions:
- The finalized rule ensures Medicare payment systems remain current and responsive to operational experience.
- Updated quality reporting programs aim to improve healthcare quality for hospital outpatient and ASC services.
- These revisions support the financial sustainability and quality oversight of Medicare-funded outpatient and ASC services.
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