Payment Matters: Calendar Year 2012 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rules Released by CMS


CMS recently released its Calendar Year (CY) 2012 Proposed Rule for outpatient services furnished in hospitals and ASCs. Among the highlights in the proposed rule are an exception process for expansion of physician-owned hospitals, which is otherwise strictly limited by the Affordable Care Act (ACA), and modifications to the Hospital Value-Based Purchasing program. The proposed rule may be viewed here [PDF]. Comments on the Proposed Rule must be received by CMS no later than 5 PM EDT on August 30, 2011.

CMS anticipates that total payments under the OPPS for CY 2012 will be $41.9 billion, and that payments to ASCs will be $3.61 billion.

Proposed Changes to the OPPS

The proposed rule projects a market basket update for CY 2012 of 1.5 percent. This reflects the 2.8 percent market basket update projected for IPPS services, minus 1.3 percent in adjustments mandated by the ACA.

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