Prospective Payment System

CMS Issues CY 2020 OPPS Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) has issued its calendar year (CY) 2020 outpatient prospective payment system (OPPS) proposed rule, including significant proposals related to price transparency and changes to the hospital area wage index (AWI). Specifically, CMS would carry over hospital AWI policies proposed under the federal fiscal year 2020 inpatient PPS (IPPS) proposed rule, applying the finalized inpatient policies to outpatient payments.

Deadline Approaching to Ensure Exact Matching on Claims Data for OPPS Providers with Multiple Locations

CHA reminds outpatient prospective payment system providers with multiple locations that the Centers for Medicare & Medicaid Services (CMS) will activate billing claims edits in July to check whether the address on a provider’s claim exactly matches the address entered into the Provider Enrollment, Chain and Ownership System (PECOS), as previously reported in CHA News.

CHA Urges Members to Comment on Area Wage Index Changes in IPPS Proposed Rule

CHA has prepared a letter template that members can use to share with the Centers for Medicare & Medicaid Services (CMS) their opposition to its proposed changes to the Medicare area wage index, outlined in the federal fiscal year (FFY) 2020 inpatient prospective payment system (IPPS) proposed rule. Member input is critical, as this proposal inappropriately and unnecessarily harms California’s hospitals.