OPPS, ASC Final Rule Boosts Medicare Reimbursement by 3.8%

UPDATED 11/02/2022 at 10:00 AM EST: The Calendar Year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule from CMS has increased Medicare reimbursement for hospital outpatient departments and established rural emergency hospitals as a new Medicare provider type.

OPPS and ASC payment rates will increase by 3.8 percent, reflecting a hospital market basket increase of 4.1 percent and a 0.3 percentage point decrease for productivity. This is higher than the 2.7 percent update included in the proposed rule.

The Consolidated Appropriations Act of 2021 introduced rural emergency hospital (REH) as a new hospital designation. Converting to REHs can help critical access hospitals (CAHs) and small rural hospitals avoid closure and maintain access to care in rural and underserved communities.

The final rule solidified participation conditions, payment rates, and Medicare enrollment requirements for REHs.

“CMS is committed to expanding access to care in rural communities and ensuring people with Medicare get the high-quality care they need,” CMS Administrator Chiquita Brooks-LaSure, said in a press release.

“Through the establishment of Rural Emergency Hospitals, supporting clinic visits at rural sole community hospitals and enabling people with Medicare to remotely access behavioral health services in their homes, today’s actions promote patient safety, equity, and quality for these underserved communities.”

CMS finalized a policy allowing clinical staff in hospital outpatient departments to provide remote behavioral health services to patients in their homes.

However, the agency also finalized its proposal to require beneficiaries to receive an in-person service within six months before their remote visit in order for providers to receive payment. Exceptions to this requirement will be allowed if the hospital staff member and beneficiary agree that the risks of an in-person service outweigh the benefits.

Building on the CMS opioid strategy, the agency will pay for five qualifying non-opioid pain management drugs when administered in ambulatory surgical centers in CY 2023. This will increase access to non-opioid drugs and encourage providers to use these drugs over opioids for pain management.

The final rule also solidified the proposal to increase hospital payments for facilities that purchase domestically made NIOSH-approved surgical N95 respirators.

CMS finalized changes to the Hospital Outpatient Quality Reporting (OQR) Program, ASC Quality Reporting Program, and REH Quality Reporting Program that aim to address disparities and improve health equity.

Following the Supreme Court’s decision in American Hospital Association v. Becerra, CMS finalized a general OPPS payment rate of average sales price plus 6 percent for drugs purchased through the 340B program.

Other updates focused on rural sole community hospitals’ exemption from the Clinic Visit Payment Policy, organ procurement and research, and coding changes for the billing of covered dental services.