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CMS Revises 2002 Outpatient PPS Rates


The Centers for Medicare and Medicaid Services (CMS) has published a final rule correcting the 2002 hospital outpatient prospective payment system (PPS) rates.  Implementation of the 2002 outpatient PPS, which was originally scheduled from January 1, 2002, has been delayed pending these corrections.  In general, these corrections, which were published in the March 1, 2002 Federal Register, mean higher payments in 2002 than were originally planned, although the rates still tend to be lower than 2001 rates.


In a November 30, 2001, final rule, CMS incorrectly assigned certain pass-through devices to several ambulatory payment classifications (APCs), causing the payments for some APCs to be set inaccurately.  The corrections included in the new final rule significantly increase payment for 13 APCs, covering procedures such as positron evaluations, and placement of certain intracoronary stents.  For all other APCs, rates remained the same or were slightly increased.


The new final rule still includes the 75 percent fold-in of new-technology transitional pass-through payments into the base rates for relevant APCs.  However, CMS has dropped the pro rata reduction on pass-through payments from 68.9 percent to 63.6 percent for services not affected by the fold-in.

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