November 8, 2023
CMS’ New Rules on Outpatient Reimbursement
The Centers for Medicare & Medicaid Services (CMS) recently released the Calendar Year 2024 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, as well as its 340B Drug Pricing Program payment remedy rule. In a new insight, Health Care Policy Analyst Jackson Hammond walks through how these rule changes will affect payment rates to care providers.
- CMS’ OPPS and ASC final rule contains a variety of payment and policy updates for Medicare Part B services, and which will result in hospitals and ambulatory surgical centers seeing payment rates increase by 3.1 percent, with total payments to providers in 2024 estimated at $96 billion, up from $89.9 billion in 2023.
- CMS is also establishing payments for intensive outpatient program services to fill the gap between traditional therapy and partial or full hospitalization and is making regulatory and technical changes to implement new benefits covering the services of marriage and family therapists, as well as mental health counselors.
- CMS’s 340B final rule will remedy previous underpayments to 340B hospitals, resulting in $9 billion in repayments to 340B hospitals and a $7.8 billion cut in non-drug items and services.