At J.L. Morgan and Associates, we stay at the front of the latest developments impacting the healthcare industry, particularly those affecting our clients. With the recent release of the final rule for the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2024, we bring you this informative blog to highlight key changes and ensure you stay informed.
As stated in the Rule, CMS confirms their plans to continue voluntary participation in the OAS CAHPS Survey through CY 2023 for HOPDs and CY 2024 for ASCs. Therefore, participation in the OAS CAHPS Survey will be linked to reimbursement beginning with CY 2024 for HOPDs and CY 2025 for ASCs.
Payment Rate Updates
The final rule implements a 3.1% increase in payment rates for most outpatient services under OPPS and ASC payment systems. This adjustment reflects the projected hospital market basket percentage increase with a productivity adjustment.
This article details changes to how hospitals are paid for outpatient services under Medicare. The payment rates are based on the type of service provided and the cost of providing that service. The article also details how hospitals can report their data to Medicare.
Quality Reporting Requirements
The final rule refines the existing quality reporting programs, including:
Hospital Outpatient Quality Reporting (OQR) Program: This program requires hospitals to report on specific quality measures related to patient care.
Hospitals failing to meet the OQR requirements will face a 2.0 percentage point reduction in their OPPS payments, translating to a nearly 2% decrease in revenue.
ASC Quality Reporting (ASCQR) Program: This program requires ASCs to report on specific quality measures related to surgical procedures.
Rural Emergency Hospital Quality Reporting (REHQR) Program: This program requires Rural Emergency Hospitals (REHs) to report on specific quality measures related to emergency care.
Hospitals and ASCs that fail to meet the reporting requirements will face a 2% reduction in their payment increase.
Additional Updates
The final rule also includes several other updates, such as:
Revisions to the bundled payment programs for certain joint replacement procedures.
Changes to the payment methodology for certain diagnostic imaging services.
Updates to the requirements for the Merit-based Incentive Payment System (MIPS).
What Does This Mean for You?
These changes are significant and can affect the way healthcare providers are reimbursed for outpatient services. J.L. Morgan and Associates encourages you to review the final rule and understand its implications for your practice. We are here to help you navigate the changes and ensure compliance.
Stay Connected with J.L. Morgan and Associates
For further updates and insights on the ever-changing healthcare landscape, stay connected with J.L. Morgan and Associates.
Additional Resources:
Medicare Program; Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Rates and Policies for Calendar Year 2024: https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0