OPPS Final Rule 2012

On November 1, 2011, in Archives, by AQ-IQ LLC

According to CMS, this final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from continuing experience with this system. This final rule with comment period, describes the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. These changes are applicable to services furnished on or after January 1, 2012.

In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from continued experience with this system. In this final rule with comment period, are the relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other rate setting information for the CY 2012 ASC payment system. These changes are applicable to services furnished on or after January 1, 2012.

Also, there are revised requirements for the Hospital Outpatient Quality Reporting (OQR) Program, added new requirements for ASC Quality Reporting System, and additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program.

CMS is also allowing eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot.

Finally, there are changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

CY 2012 OPPS Claims Accounting [PDF, 78KB]

CY 2012 OPPS Cancer Adjustment Analysis File [ZIP, 291KB]

CY2012 Outlier and Rural Adjustment [PDF, 25KB]

PDF version, 18.95MB

Text version, 2.4MB

CY 2012 OPPS Median Files

CY 2012 OPPS Addenda

CY 2012 OPPS Facility-Specific Impacts

CY 2012 OPPS Blood Revenue Code cost to Charge Ratios

CY 2012 OPPS Without Cost or With Credit Device Information

CY 2012 OPPS Preamble Tables

Final Rule Changes to the Ambulatory Surgical Center Payment System and CY 2012 Payment Rates

 

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