Medicare Outpatient Prospective Payment System (OPPS) Changes for 20101
Most separately payable Medicare Part B-covered drugs that are administered by physicians in the hospital outpatient setting will be reimbursed at a rate of ASP + 4 percent in 2010.
That was one of several provisions finalized in the Medicare Hospital Outpatient Prospective Payment System (OPPS) for 2010. The changes are effective from January 1, 2010, to December 31, 2010.
Under the Final Rule, which was published November 20, 2009, in the Federal Register, hospital outpatient departments will receive a projected market basket update for CY 2010 of 2.1 percent if they participate in the Hospital Outpatient Department Quality Data Reporting Program (HOP QDRP). This would result in a full market basket conversion factor for 2010 of $67.406. CMS projects that these rates would result in a 1.9 percent increase in reimbursement for providers paid under the OPPS. Hospitals that do not participate in quality reporting for outpatient services or fail to report the data correctly will see a drop in their outpatient Medicare reimbursements by 2 percentage points, resulting in a net 0.1 percent update.
1Federal Register, Vol. 74 No. 223, November 20, 2009, Rules and Regulations.
Coverage policies may vary by insurer or even between plans offered by the same insurer. This information is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current, the information may not be as current or comprehensive when you view it. Please consult with your counsel or reimbursement specialist for any reimbursement or billing questions.
Last Modified Date: 04/26/2010