Prospective Payment

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December 2017
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CMS finalizes outpatient PPS, ASC payment system, quality reporting changes for 2018

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on November 1 announced it will update the hospital outpatient prospective payment system rates by 1.35%. The final rule also removes total knee arthroplasty from the inpatient only list along with five other procedures and adds one procedure to the…

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By: Judy Mathias
November 2, 2017
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CMS releases FY 2018 inpatient PPS final rule

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on August 2 issued the FY 2018 Medicare Inpatient Prospective Payment System final rule, which updates Medicare payment and policies when patients are discharged from hospitals. The rule increases rates by 1.2%. This includes an initial market-basket update of 2.7%…

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By: Judy Mathias
August 4, 2017
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CMS issues 2018 OPPS/ASC proposed payment rule

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on July 13 issued the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. CMS is proposing an update of 1.9% for ASCs, which is a combination of a 2.3% inflation update…

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By: Judy Mathias
July 18, 2017
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CMS proposes paying for outpatient total joints

Editor's Note The Centers for Medicare & Medicaid Services on July 13 issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. Among the proposals are that Medicare pay for knee replacement procedures performed in outpatient…

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By: Judy Mathias
July 17, 2017
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CMS releases proposed FY 2018 inpatient payments, policies

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on April 14 issued a proposed rule that would update FY 2018 Medicare inpatient payments and policies. Among the changes, the rule: would increase payment rates by 1.6%, after accounting for inflation and other adjustments required by law includes an…

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By: Judy Mathias
April 18, 2017
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The Shifting Sands of the Financial Healthcare Hourglass: Preparing for Bundled Payment Initiatives

Whether your facility volunteered, was mandated, or is simply sitting on the sidelines, you will be part of a bundled payment initiative in the near future. How do you prepare today? The Patient Protection and Affordable Care Act (ACA) empowered Medicare to create a “national pilot program on payment bundling…

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Hospitals still using chargemaster markups to improve revenue

Editor's Note Since Medicare adopted its prospective payment system in 1985, many hospital executives and economists have suggested that the hospital chargemaster (list of prices for all hospital procedures and supplies) is irrelevant. However, in this study, researchers found that hospitals are systematically adjusting their charge-to-cost ratios (ie, chargemaster price…

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By: Judy Mathias
September 12, 2016
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CMS issues final PPS rule for 2017

Editor's Note The Centers for Medicare & Medicaid Services on August 2 issued its final rule for the FY 2017 hospital inpatient prospective payment system (PPS), which increases rates by 0.95%. The 0.95% increase reflects the projected hospital market basket update of 2.7% for those hospitals that were meaningful users…

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By: Judy Mathias
August 5, 2016
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CMS releases OPPS, ASC proposed rule for 2017

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on July 14 published the 2017 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule.  Among the proposals:  an increase in OPPS payment rates by 1.55%--a combination…

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By: Judy Mathias
July 13, 2016
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CMS issues hospital inpatient PPS proposed rule for FY 2017

Editor's Note The Centers for Medicare & Medicaid Services on April 18 issued its hospital inpatient prospective payment system (PPS) proposed rule for FY 2017. The proposed rule includes: an increase in rates by 0.85% from FY 2016, after accounting for inflation and other adjustments required by law adjustments to…

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By: Judy Mathias
April 21, 2016
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Inpatient PPS proposed rule drops two-midnight payment cuts

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on April 18 issued its hospital inpatient prospective payment system (PPS) proposed rule for FY 2017 that includes two adjustments to reverse the effects of the 0.2% cut it instituted when implementing the two-midnight rule, AHA News Now reports. Included…

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By: Judy Mathias
April 19, 2016
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