Health Law Alert: TRICARE Announces Implementation of Medicare's Outpatient Prospective Payment System


TRICARE is the Department of Defense (DoD) health care system that delivers care to its approximately 8.7 million uniformed services beneficiaries (active duty, retirees, and dependents of each) through military treatment facilities or through arrangements with non-DoD facilities that contract with intermediaries. In 2001, Congress mandated that TRICARE conform its payment methodologies to those used by Medicare.1

On December 10, 2008, as the most recent step in implementing this mandate, DoD released a final rule implementing a hospital outpatient prospective payment system (OPPS) for TRICARE that is based on that used by Medicare.2 Currently, outpatient services rendered to TRICARE patients are reimbursed under allowable charge methodologies that include CHAMPUS Maximum Allowable Charge rates and Ambulatory Surgery Rates. Under the new TRICARE OPPS, hospital outpatient services will be paid on a rate-per-service basis that varies according to the Ambulatory Payment Classification (APC) group to which the services are assigned. The Level I Current Procedural Terminology and Level II Healthcare Common Procedure Coding System codes and descriptors will be used to identify and group the services within each APC.

Please see full alert for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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