CMS pitches outpatient payment rule: 5 things to know

CMS has released its Outpatient Prospective Payment System proposed rule for 2023, which would raise Medicare outpatient payment rates next year. 

Five takeaways from the 886-page proposed rule

1. Payment update. CMS proposed increasing OPPS rates for hospitals that meet quality reporting requirements by 2.7 percent in 2023 compared to this year. The department estimates that total payments to providers would be $86.2 billion in 2023, up $6.2 billion from 2022.

2. Inpatient only list. CMS proposed removing 10 services from the inpatient only list next year. The procedures were removed from the list in 2021 as part of the first phase of eliminating the IPO list, but they were added back to the list when the elimination process was halted last year. CMS said the codes for the maxillofacial procedures "meet the current criteria to remove services from the IPO list." 

3. 340B program. CMS said it anticipates applying a payment rate of average sales price plus 6 percent to certain drugs purchased through the 340B Drug Pricing Program. "We are still evaluating how to apply the Supreme Court's recent decision to prior calendar years," CMS said in a fact sheet.

4. Rural emergency hospitals. The proposed rule includes a payment model for rural emergency hospitals, including a monthly facility payment. "To improve access to all types of care in rural settings, CMS is broadly proposing to consider all covered outpatient department services … as REH services," CMS said. Rural emergency hospitals would be paid for providing services at a rate that is equal to the OPPS rate plus an additional 5 percent payment. 

5. Comment period. Public comments on the proposed rule are due by Sept. 13. 

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