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In a resounding victory for essential hospitals, the U.S. Supreme Court unanimously ruled in favor of America’s Essential Hospitals in its years-long legal challenge to restore full Medicare payment rates for 340B Drug Pricing Program hospitals.

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policy

Final rules for Medicare’s OPPS and PFS for CY 2022 continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program; continue site-neutral payment policies; and halt elimination of the inpatient-only (IPO) list.

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policy

The Medicare Outpatient Prospective Payment System final rule for calendar year 2022 continues cuts to hospitals in the 340B Drug Pricing Program and pauses elimination of the inpatient-only list. The rule also includes provisions on price transparency, rural emergency hospitals, and health equity.

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By maintaining harmful cuts to outpatient drug payments for hospitals in the 340B Drug Pricing Program and for services at hospital outpatient clinics, the 2022 Outpatient Prospective Payment System final rule jeopardizes safety net care.

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policy

Proposed rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule would continue Medicare Part B cuts, continue site-neutral policies, and halt the phase-out of the inpatient-only list. Both rules also contain an information request on closing the health equity gap.

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policy

The OPPS proposed rule would continue cuts to hospitals in the 340B Drug Pricing Program and off-campus provider-based departments, pause the elimination of the inpatient-only list, and increase penalties for failing to report standard charges.

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America's Essential Hospitals expresses its disappointment with the administration's decisions to stand by a bad policy on Part B drug payments and to continue damaging cuts to outpatient care.

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policy

The Supreme Court’s decision to review the case marks a significant step in the association’s efforts to overturn harmful Medicare Part B cuts to hospitals in the 340B Drug Pricing Program. The Supreme Court will hear oral arguments in the case in its next term, with a decision likely in 2022.

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policy

The Centers for Medicare & Medicaid Services will begin reprocessing outpatient claims to excepted off-campus provider-based departments at the lower site neutral payment rate it established in the calendar year 2019 Outpatient Prospective Payment System final rule.

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policy

Final rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2021 continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program and site-neutral payment policies.

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policy

The Medicare Outpatient Prospective Payment System final rule for calendar year 2021 continues cuts to hospitals in the 340B Drug Pricing Program and off-campus provider-based departments, and updates the overall hospital star ratings methodology.

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The final rule takes critical resources away from hospitals and is especially harmful now as they strain under the heavy financial burden of COVID-19.

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policy

The Centers for Medicare & Medicaid Services (CMS) on Dec. 1 will retire its original Hospital Compare tools, encouraging users to visit Medicare.gov’s new Care Compare tool to find and compare health care providers. CMS will not update the overall hospital quality star ratings in January 2021.

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policy

The interim final rule targets future vaccine costs, price transparency for COVID-19 tests, and enhanced Medicare payments for new COVID-19 treatments.

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The proposed rules would deepen Medicare Part B cuts to hospitals in the 340B Drug Pricing Program, continue site-neutral payment policies, and revise the overall hospital star rating methodology. The association urged CMS to protect funding for essential hospitals and access to care.

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policy

The webpage includes checklists, step-by-step instructions, and FAQs to help hospitals comply with the Hospital Price Transparency Rule, effective Jan. 1, 2021. It also offers information to help consumers use the data.

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policy

Proposed rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2021 would deepen Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program, continue site-neutral payment policies, and revise the overall hospital star rating meth

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policy

The Medicare Outpatient Prospective Payment System proposed rule for calendar year 2021 would deepen cuts to hospitals in the 340B Drug Pricing Program, continue cuts to off-campus provider-based departments, and update the overall hospital star ratings methodology.

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The Medicare Outpatient Prospective Payment System proposed rule takes a bad policy on Part B drug payments and makes it worse by digging an even deeper financial hole for essential hospitals and their vulnerable patients.

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policy

The survey will run April 24 to May 15 and requests drug acquisition costs from all hospitals participating in the 340B Drug Pricing Program, except critical access hospitals. CMS might use data collected through the survey to determine Medicare Part B drug reimbursement rates.

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policy

Beginning Jan. 1, 2020, CMS will start to adjust claims that were paid at the reduced rate. The agency also filed a notice appealing its case to the U.S. Court of Appeals for the District of Columbia Circuit.

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policy

New requirements call for hospitals to post charges and information based on rates negotiated with third-party payers, as well as standard charge data for a limited set of “shoppable” services, in a consumer-friendly manner.

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The agency published new requirements for hospitals to publicly post standard charges, including information based on rates negotiated with third-party payers. 

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policy

The final rules for Medicare’s Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2020 also expand access to opioid use disorder treatment and establish a prior authorization process for certain services.

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In a separate, forthcoming final rule, the Centers for Medicare & Medicaid Services will summarize and respond to the more than 1,400 public comments it received about proposed requirements for hospitals to make public their standard charges.

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The final rule jeopardizes access to care in underserved communities and flouts court rulings on unlawful federal policies regarding payments to hospitals in the 340B Drug Pricing Program and to provider-based outpatient departments.

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policy

The association urged the Centers for Medicare & Medicaid Services to reverse policies that will result in significant funding cuts to essential hospitals and hinder access to care.

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A U.S. District Court judge has invalidated a Centers for Medicare & Medicaid Services policy that made a $380 million payment cut this year to off-campus, provider-based departments previously exempt from site-neutral reductions.

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Beginning in April 2020, hospitals with multiple service locations must accurately enter the address of their off-campus, provider-based departments.

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America's Essential Hospitals details key provisions of the proposed rules for the Medicare Outpatient Prospective Payment System and Physician Fee Schedule for calendar year 2020.

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policy

The Medicare Outpatient Prospective Payment System proposed rule for calendar year 2020 would continue cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments and introduce new transparency requirements.

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policy

The calendar year 2020 proposed rule includes updates to the Quality Payment Program, a request for information on the creation of Merit-based Incentive Payment System Value Pathways, and other topics of interest to essential hospitals.

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The proposed rule needlessly prolongs the uncertainty, confusion, and harm the Centers for Medicare & Medicaid Services created when it unlawfully cut payments to hospitals in the 340B Drug Pricing Program.

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policy

The final judgement, in favor of America's Essential Hospitals, does not indicate how the Department of Health and Human Services should remedy unlawful payment reductions to hospitals in the 340B Drug Pricing Program in 2018 and 2019.

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Under the requirement, delayed until October, the address a hospital lists on a claim will have to exactly match agency enrollment records for the hospital to receive payment through the Outpatient Prospective Payment System.

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policy

In July, the Centers for Medicare & Medicaid Services will require hospitals with multiple service locations to accurately enter the address of their off-campus, provider-based departments to receive payment through the Outpatient Prospective Payment System.

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policy

A federal judge found the Department of Health and Human Services’ Medicare outpatient payment cuts in 2019 to hospitals in the 340B Drug Pricing Program were unlawful, extending a similar decision regarding 2018 cuts. The case was sent back to the agency to determine the appropriate remedy.

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The report includes recommendations on several issues of importance to essential hospitals, including hospital inpatient and outpatient services, hospital quality incentive programs, and alternatives to opioids.

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policy

The lawsuit asserts that the policy adopted by the Centers for Medicare & Medicaid Services is unlawful and unenforceable because it conflicts with federal statutes and violates congressional intent.

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policy

America’s Essential Hospitals and other plaintiffs have asked the U.S. District Court for the District of Columbia to order the federal government to restore losses caused by Medicare outpatient payment cuts to 340B hospitals.

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policy

The Outpatient Prospective Payment System and Physician Fee Schedule final rules for calendar year 2019 expand damaging site-neutral payment policies and continue Medicare Part B drug payment cuts to hospitals in the 340B Drug Pricing Program.

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policy

The Medicare Outpatient Prospective Payment System final rule for calendar year 2019 broadens the scope of cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments; in a statement, the association strongly objected to these additional payment cuts.

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The rule undermines stability and choice for vulnerable patients by continuing to cut critical funding to hospitals serving people who face barriers to care.

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policy

As midterm elections loom, Congress sent to the president the federal government's first comprehensive policy response to the nation's opioid crisis; a bipartisan House letter questions outpatient payment cuts; and New Hampshire senators introduced surprise billing legislation.

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policy

America’s Essential Hospitals urged the Centers for Medicare & Medicaid Services to reverse policies that will result in significant funding cuts to essential hospitals and hinder access to care.

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policy

Two senators lead a letter-signing campaign to stop the expansion of hospital outpatient department cuts; in a 99-1 vote, the Senate approves legislation to combat the opioid crisis and is poised to vote on a spending bill for fiscal year 2019.

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policy

The Centers for Medicare & Medicaid Services has released Outpatient Prospective Payment System and Physician Fee Schedule proposed rules for calendar year 2019 that would expand site-neutral payment policies and continue Medicare Part B drug payment cuts to 304B hospitals.

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policy

A new proposed rule for Medicare’s Outpatient Prospective Payment System would broaden the scope of cuts to hospitals in the 340B Drug Pricing Program and to off-campus provider-based departments; it also contains provisions related to quality reporting and transparency.

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The rule would make bad policies worse, impose draconian new cuts that jeopardize access to care, and undermine the foundation of the nation's health care safety net.

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policy

The report provides updates on the Hospital Readmissions Reduction Program, off-campus emergency department access, the physician fee schedule, population-based quality measures and incentives, and Medicare accountable care organizations, among other topics.

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policy

The plan cites and builds on proposed changes to the 340B Drug Pricing Program in the president’s fiscal year 2019 budget, as well as damaging cuts implemented through the calendar year 2018 Outpatient Prospective Payment System final rule.

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policy

On May 4, America’s Essential Hospitals and fellow plaintiffs will make oral arguments in a legal battle to reverse damaging Medicare cuts to hospitals in the 340B Drug Pricing Program; The public can watch via livestream.

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policy

The Centers for Medicare & Medicaid Services offers details on how Medicare Advantage plans might be affected by reimbursement reductions in the calendar year 2018 Outpatient Prospective Payment System final rule.

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policy

The Centers for Medicare & Medicaid Services will audit mid-build certifications this year and should complete all audits by December 2018.

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policy

Tax reform legislation heads to a House-Senate conference committee. Meanwhile, a bill to delay Medicaid disproportionate share hospital payment cuts could be included in year-end legislation.

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The lawsuit argues that the 340B provisions of the Centers for Medicare & Medicaid Services’ outpatient prospective payment system rule violate the Social Security Act and should be set aside under the Administrative Procedure Act as unlawful and in excess of the HHS Secretary’s statutory authority.

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policy

America’s Essential Hospitals is closely reviewing the final rules and pursuing strategies to protect our members from these devastating cuts. Key aspects of the recently released final rules are summarized in this Action Update.

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webinar

Dive into the policy details of the CMS rule that cuts 340B program savings, and hear how America’s Essential Hospitals plans to respond.

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policy

The rule cuts 340B Drug Pricing Program payments by $1.6 billion and requires hospitals to use modifiers to identify 340B drugs in Medicare claims.

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The final rule's cuts to Medicare Part B drug payments to 340B hospitals jeopardizes health care access for millions of low-income individuals and families nationwide and weakens the ability of essential hospitals to provide vital services to communities.

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policy

The harmful payment reduction was included in the 2018 Outpatient Prospective Payment System proposed rule, expected to be finalized this fall.

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policy

The meeting came a day after the association submitted comments to the agency in response to the proposed annual update of the Hospital Outpatient Prospective Payment System.

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policy

The proposed rule would further cut payments to non-excepted provider-based departments to 25 percent of the Medicare Outpatient Prospective Payment System rate and change certain quality reporting requirements.

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webinar

The latest from experts on the CMS proposed policy rules that cut 340B savings and support for outpatient services in underserved areas.

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policy

The Medicare Physician Fee Schedule proposed rule for calendar year 2018 includes physician payment and quality program changes.

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policy

The proposed rule would increase outpatient payment rates by 1.75 percent and drastically reduce Medicare Part B reimbursement for drugs purchased through the 340B Drug Pricing Program.

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webinar

The policy team at America's Essential Hospitals discussed the regulatory outlook for the next year, including key policy issues on the horizon.

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policy

Essential hospitals can expect the new Congress' Republican leaders to follow through quickly with their pledge to repeal the Affordable Care Act.

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A CMS spokesperson said the project was pulled after the agency reviewed public comments — there were more than 1,300 comments submitted, mostly negative.

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The legislation, expected to quickly receive the president's signature, includes two key advocacy goals for the association: risk adjustment of the Hospital Readmissions Reduction Program and partial relief from hospital outpatient department payment cuts.

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policy

Congress is poised to pass legislation that would include socioeconomic risk adjustment for the Hospital Readmissions Reduction Program and some relief from payment cuts for new hospital outpatient departments.

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Under the rule, CMS would increase the OPPS payment rate by 1.65 percent and provide flexibility in the meaningful use of EHRs, among other things.

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webinar

Join us to discuss the policies, outlined by CMS, for the implementation of the site neutral law.

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policy

CMS provides more flexibility than previously proposed, ensuring non-grandfathered, off-campus hospital outpatient departments will be reimbursed in 2017.

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In the rule, CMS revised its earlier position not to direct any physician fee schedule payments to non-grandfathered, off-campus hospital clinics in 2017 and, instead, established a 50 percent interim rate.

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While the final rule provides some relief from onerous proposed payment policies, it continues to put underserved communities at risk of further declines in access to care, the association says.

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webinar

CMS recently proposed policies for implementing the site neutral law – join us July 26 to discuss the impacts this will have on your hospital.

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policy

The proposed rule updates the payment rate for services provided in hospital outpatient departments and provisions relating to quality reporting.

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policy

The proposed rule would implement Section 603 of the Bipartisan Budget Act, which reduced payments for new, off-campus hospital outpatient departments.

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policy

America's Essential Hospitals denounces the Centers for Medicare & Medicaid Services decision to limit flexibility and withhold hospital payments for new, off-campus hospital outpatient departments.

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policy

A 2015 budget law that creates site-neutral payment for off-campus hospital outpatient departments does not directly affect 340B Drug Pricing Program eligibility, but changes to how hospitals report Medicare costs does raise concerns.

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policy

In letter to CMS, association raises issues of payment, definition of off-campus outpatient department of a provider, and 340B eligibility.

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Changes include reducing OPPS payment by 0.3 percent, relaxing two-midnight policy requirements, and updating OQR measures.

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In comments on the CY 2016 OPPS proposed rule, the association calls on CMS to consider the unique challenges of caring for the most vulnerable, including in relation to the two-midnight policy and ambulatory payment classification.

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RACs will not conduct postpayment reviews of patient status for Medicare claims with an inpatient admission between Oct. 1 and Dec. 31, 2015.

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policy

Agency proposes to reduce slightly payment rates for hospital outpatient services, relax some provisions of the two-midnight policy, and update quality reporting measures.

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policy

In a new policy brief, America's Essential Hospitals describes how billions of dollars in reductions to Medicaid and Medicare funding threaten care at essential hospitals.

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policy

Topics of member interest include payment updates, the OQR Program, and the MSSP.

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policy

The rules, released Oct. 31, finalized a number of provisions regarding payments, data collection in outpatient departments, quality programs, and the MSSP.

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The association urged CMS to revise its C-APC proposal and opposed its proposal to add a claims-based modifier for every outpatient service provided in off-campus provider-based departments.

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policy

The agency proposes to increase payment rates by an outpatient department fee schedule increase factor of 2.1 percent for CY 2015. CMS also proposes to collect data on services provided in off-campus provider-based departments by requiring hospitals and physicians to identify these services using a modifier on hospital and physician claims.

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policy

CMS released the rule July 3. The agency proposes to increase payment rates by an outpatient department fee schedule increase factor of 2.1 percent for CY 2015. In addition, CMS proposes to collect data on services provided in off-campus provider-based departments by requiring hospitals and physicians to identify these services using a modifier on hospital and physician claims.

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policy

The measure, OP-31/ASC-11, is part of the ASC Quality Reporting Program and the OQR Program. Data collection, which was scheduled to begin April 1, will now begin Jan. 1, 2015. America's Essential Hospitals successfully encouraged CMS to delay the measure, arguing the measure was not properly tested for the ASC and outpatient settings.

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policy

Voted unanimously to recommend Congress increase Medicare payments rates for FY 2015 OPPS

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policy

The rule replaces outpatient visit codes with a single code describing all clinic visits

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policy

On November 27, the Centers for Medicare & Medicaid Services (CMS) issued the Outpatient Prospective Payment System (OPPS) final rule for calendar year (CY) 2014. Included in the rule are provisions related to the following: payment for hospital outpatient visits data collection in off-campus, provider-based departments Hospital Outpatient Quality Reporting (OQR) Program Hospital Value-Based Purchasing

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policy

Rule finalizes several Outpatient Prospective Payment System provisions

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OPPS is used by CMS for hospital outpatient services under Medicare

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The final rule was delayed due to the partial government shutdown

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Suggests CMS convene hospital industry work group to better understand off-campus outpatient care

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Rule proposes several outpatient prospective payment system provisions

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policy

Agency seeks to understand type and frequency of, and payment for, services furnished in off-campus outpatient departments

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policy

Commissioners vote unanimously to recommend 1 percent increases for fiscal year 2014

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