Medicare Hospital Outpatient
Prospective Payment System (OPPS) Changes for 20111
Most separately payable Medicare Part B-covered drugs that are administered in the hospital outpatient setting will be reimbursed at a rate of Average Sales Price (ASP) + 5 percent in 2011. This does not include new drugs that are eligible for pass-through payment. These drugs will be reimbursed based on ASP + 6 percent.
That was one of several provisions finalized in the Medicare Hospital Outpatient Prospective Payment System (OPPS) for 2011. The changes are effective from January 1 to December 31, 2011.
Under the Final Rule, which was published November 24, 2010, in the Federal Register, the finalized conversion factor is $68.876. Hospitals that do not participate in quality reporting for outpatient services or fail to report the data correctly will see a drop in their outpatient Medicare reimbursements by 2 percentage points, resulting in the reduced conversion factor of $67.530.
1 Federal Register Vol. 75, No. 226. Nov. 24, 2010. Rules and Regulations.
Coverage policies may vary by insurer or even between plans offered by the same insurer. This information is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current, the information may not be as current or comprehensive when you view it. Please consult with your counsel or reimbursement specialist for any reimbursement or billing questions.