CMS Releases Proposed Rule For 2019 Hospital Outpatient Prospective Payment System

On July 25, the Centers for Medicare and Medicaid Services (CMS) released proposed changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for 2019.

Highlights from the proposed rule include:

  • Moving toward site neutral payments for clinic visits offered under OPPS, potentially lowering the average OPPS payment by $70, aligning OPPS payment with the Physician Fee Schedule payment amount.
  • Adding 12 cardiac catheterization procedures to the list of covered procedures that can be performed in an ASC.
  • Updating ambulatory payment classifications (APCs) for endovascular procedures, particularly those using drug-coated balloons.
  • Updating the APC structure for imaging procedures, with and without contrast, an ongoing area of review for the ACC and other societies in recent years.

The proposed rule also includes efforts to continue measure alignment for the Hospital Outpatient Quality Reporting Program and promotes interoperability and data exchange, both of which were addressed in the 2019 proposed rules for the Hospital Inpatient Prospective Payment System and the Physician Fee Schedule.

ACC staff are actively reviewing the proposed rule to identify additional topics of interest to members. The College will submit written comments to CMS in the coming months. Additional information will be available in the ACC Advocate newsletter and on ACC.org.

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services (U.S.), Outpatients, Inpatients, Prospective Payment System, Medicare, Fee Schedules, Medicaid, Ambulatory Care, Endovascular Procedures, Cardiac Catheterization


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