Medicare OPPS

CMS Will Issue OPPS Providers Lump-Sum Payments to Remedy 340B Losses

November 3, 2023 - Hospital Outpatient Prospective Payment System (OPPS) providers participating in the 340B drug pricing program will receive a one-time lump-sum payment to offset losses between calendar years (CYs) 2018 and 2022, according to a final rule provision from CMS. Before 2018, the Medicare payment rate for 340B drugs provided to outpatient hospitals was...

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Healthcare Orgs Address Price Transparency, 340B Policies in OPPS

by Victoria Bailey

Hospital and specialty groups are urging CMS to amend aspects of the CY 2024 Outpatient Prospective Payment System (OPPS) proposed rule, including 340B Drug Pricing Program policies and price...

OPPS Rule to Update Outpatient Payments, Hospital Price Transparency

by Jacqueline LaPointe

CMS proposes in the Outpatient Prospective Payment (OPPS) rule to increase Medicare outpatient payments by 2.8 percent next year while bolstering hospital price transparency enforcement. The OPPS rule...

CMS to Resolve 340B Payment Mixup With $9B Lump-Sum Fix

by Jacqueline LaPointe

CMS has proposed to pay $9 billion to hospitals impacted by payment cuts to the 340B Drug Pricing Program between 2018 and 2022. The proposal is CMS’ remedy to cutting 340B payments from the...

Judge Wants HHS to Remedy 340B Underpayments to Hospitals

by Jacqueline LaPointe

A federal court has decided to let HHS determine how to repay hospitals for years of 340B underpayments. The decision issued Tuesday by the US District Court for the District of Columbia comes as a...

OPPS, ASC Final Rule Boosts Medicare Reimbursement by 3.8%

by Victoria Bailey

UPDATED 11/02/2022 at 10:00 AM EST: The Calendar Year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule from CMS has...

CMS Will Apply Higher 340B Hospital Reimbursement Rate After Court Ruling

by Jacqueline LaPointe

Following a court order, CMS is revising its methodology for paying 340B hospitals for outpatient drugs and reprocessing claims paid on or before the Sept. 28th ruling. CMS will reimburse hospitals...

AHA Responds to Medicare Outpatient Payment Updates for CY 2023

by Victoria Bailey

When commenting on the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule for calendar year (CY) 2023, the American...

CMS Proposes 2.7% Increase in CY23 OPPS, ASC Reimbursement Rates

by Victoria Bailey

CMS has released its Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule for calendar year (CY) 2023, which includes a 2.7 percent...

Hospitals Win Supreme Court Case on 340B Reimbursement Cuts

by Victoria Bailey

The US Supreme Court has sided with the American Hospital Association (AHA) and other hospital groups and determined that the 340B Medicare reimbursement cuts for hospitals were unlawful. In the 2018...

Hospital Price Transparency Penalties to Increase Under OPPS Rule

by Jacqueline LaPointe

Starting January 1, CMS will increase penalties for noncompliance with hospital price transparency requirements under the newly released Calendar Year (CY) 2022 Hospital Outpatient Prospective Payment...

CMS to Start Reprocessing Site-Neutral Outpatient Claims

by Victoria Bailey

CMS will begin to reprocess claims for outpatient clinic visit services provided at excepted off-campus provider-based departments, following a reinstated site-neutral payment policy. The agency will...

CMS Holds Off on Hospital Price Transparency Noncompliance Penalties

by Jill McKeon

CMS will hold off on hospital price transparency noncompliance penalties for the moment, a CMS spokesperson told Bloomberg Law. CMS proposed an increase in penalty amounts for noncompliant hospitals in...

Hospital Pros and Cons of the CY 2022 OPPS Proposed Rule

by Jacqueline LaPointe

The newly proposed Medicare Outpatient Prospective Payment System (OPPS) rule for calendar year (CY) 2022 is causing a stir with new hospital price transparency enforcement rules and other...

CMS Proposes 2022 OPPS Rates, Higher Hospital Price Transparency Penalty

by Jacqueline LaPointe

CMS is seeking greater hospital price transparency enforcement through the newly proposed Medicare Outpatient Prospective Payment System (OPPS) rule for calendar year (CY) 2022. The rule proposed...

Supreme Court Will Not Hear Site-Neutral Payment Case

by Jacqueline LaPointe

The Supreme Court has declined to take up a lawsuit filed by the American Hospital Association (AHA) that aimed to reverse Medicare’s site-neutral payment policy for clinic visits furnished to...

Site-Neutral Payment Case Lacks Merit, HHS Tells Supreme Court

by Jacqueline LaPointe

HHS is asking the Supreme Court to bypass a case brought on by hospital groups challenging site-neutral payment rates for certain outpatient evaluation and management (E/M) services, which the...

Hospital Outpatient Payment Would Suffer If 340B Cuts Reversed

by Jacqueline LaPointe

Outpatient payments would decrease for the majority of hospitals if HHS reversed a controversial policy reducing 340B drug reimbursement, according to a new Avalere analysis. The analysis examined...

Hospitals Ask Supreme Court to Take Up 340B, Site-Neutral Payments

by Jacqueline LaPointe

The American Hospital Association (AHA), joined by member hospitals and other national organizations, have filed petitions asking the Supreme Court to reverse two appeals court decisions impacting...

CMS to Reprocess Some Outpatient Claims After Site-Neutral Ruling

by Jacqueline LaPointe

CMS has announced that it will reprocess hospital outpatient claims from last year for clinic visit services provided at excepted off-campus provider-based departments. The agency will start...

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