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CHA Issues Summary of CY 2019 OPPS Final Rule

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CHA has issued a summary of the Centers for Medicare & Medicaid Services’ final rule addressing rate updates and policy changes to the Medicare outpatient prospective payment system (OPPS) and ambulatory surgical center payment system for calendar year (CY) 2019.

The final rule includes annual updates to the Medicare fee-for-service outpatient payment rates, as well as regulations that implement new policies. It includes policies that will:

  • Make payment changes for excepted and non-excepted clinic visits furnished in off-campus provider-based departments (PBDs)
  • Extend the 340B drug payment adjustment of average sales price minus 22.5 percent to non-excepted PBDs
  • Change the rate for biosimilars purchased by hospitals through the 340B program
  • Change the inpatient-only list
  • Change exceptions to the list of services that are packaged into ambulatory payment classifications, as opposed to separately paid

CHA DataSuite issued hospital-specific analyses intended to show providers how Medicare outpatient fee-for-service payments will change from CY 2018 to CY 2019 based on the final rule’s policies.