CMS Releases Hospital OPPS Final Rule: Overview & Highlights

The Centers for Medicare and Medicaid Services (CMS) on Nov. 1 released the final CY 2023 Outpatient Prospective Payment (OPPS) rule, which indicates a 3.8% payment update for hospitals based on a projected increase in the hospital market basket of 4.1%, reduced by 0.3% for the productivity adjustment.

ACC's Advocacy Team has identified the following OPPS provisions that may be of interest to cardiovascular clinicians:

  • Decision to use cost report data from the June 2020 Healthcare Cost Report Information System (HCRIS), which consists of cost report data through CY 2019, predating the COVID-19 pandemic and Public Health Emergency. This is the same cost report extract used to set OPPS rates for CY 2022.
  • Removal of 11 services from the inpatient only (IPO) list, addition of six services to the IPO, and addition of four services to the ambulatory surgical center (ASC) covered procedures list (CPL). None of these services are cardiology related.
  • Regulations to create and pay for Rural Emergency Hospitals (REHs), a new provider type established by the 2021 Consolidated Appropriations Act.
  • CMS continued its policy of separate payment for software as a service (SaaS) services, even when they are add-on services. With SaaS-type technology becoming more widespread, CMS had been seeking feedback through a request for information regarding specific payment approaches that may be deployed for these services. The Agency indicated more proposals may be forthcoming in future rulemakings.
  • Payment adjustments to incentivize purchase of fully domestically produced N95 masks.
  • The MicroTransponder® ViviStim® Paired Vagus Nerve Stimulation System (ViviStim System®) was approved for transitional pass-through payment status.
  • Finalized payment changes in the ASC setting for non-opioid pain management drugs as surgical supplies to ensure there are no financial disincentives to using non-opioid options.
  • Finalized changes to regulation to address financial barriers to organ donation after cardiac death. Certain procedures needed for preparation of an organ donor will be allowed to be billed to the Organ Procurement Organization (OPO) when death is imminent rather than only after donor is deceased. This is to avoid services necessary for transplant being billed to the donor's insurance or family, which has been a potential barrier to organ donation.
  • CMS finalized the creation of a single blended payment for Category B Investigational Device Exemption Clinical Devices and Studies. CMS will either establish a new HCPCS code or revise an existing HCPCS code for devices and services in these studies when the Medicare coverage IDE study criteria are met and where CMS determines a code and/or payment rate is necessary to preserve scientific validity of these studies by avoiding differences in Medicare payment that may reveal the treatment or control group in which a patient has been assigned.

For more information, you can find the press release here; the general fact sheet here; the Rural Emergency Hospital-specific fact sheet here; and supplementary addenda and data tables can be found here. ACC staff will continue to review the rule to identify any additional topics of interest. Look for updates on and future issues of The Advocate newsletter.

Clinical Topics: COVID-19 Hub

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Medicare, Healthcare Common Procedure Coding System, Outpatients, COVID-19, Control Groups, Feedback, Inpatients, Motivation, N95 Respirators, Pain Management, Pandemics, Vagus Nerve Stimulation, Information Systems, Tissue and Organ Procurement, Health Care Costs, Death, Tissue Donors, Cardiology, Technology, Software, Policy

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