Prospective Payment System

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.

CHA is currently reviewing the Centers for Medicare & Medicaid Services’ calendar year (CY) 2020 proposed rule for the home health (HH) prospective payment system (PPS).

The Centers for Medicare & Medicaid Services (CMS) has postponed the activation of billing edits requiring exact matching for the address on claims data for outpatient prospective payment system providers with multiple service locations. The edits will now be implemented in October 2019.  

CHA has submitted a comment letter on the Centers for Medicare & Medicaid Services’ (CMS) federal fiscal year (FFY) proposed rule for the long-term care hospital (LTCH) prospective payment systems (PPS). 

CHA has submitted a comment letter on the federal fiscal year (FFY) 2020 inpatient prospective payment system (IPPS) proposed rule issued by the Centers for Medicare & Medicaid Services (CMS).

CHA has submitted comments on the Centers for Medicare & Medicaid Services’ (CMS) federal fiscal year (FFY) 2020 proposed rules for the prospective payment systems (PPS) for inpatient rehabilitation facilities (IRFs) and skilled-nursing facilities (SNFs). 

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 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. 

On May 28, the Centers for Medicare & Medicaid Services (CMS) issued new instructions for providers billing Chimeric Antigen Receptor (CAR) T-Cell therapy services for Medicare patients.