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2007 Final Rule Changes to the Medicare Hospital Outpatient Prospective Payment System

Session #: 81683-xh
Presenter(s): Larry Goldberg
Session Length: 1hr. 40 min.
Event: 2006 HFMA Audio Webcast
Date: 11-28-06

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CMS posted on its web site, November 1, the final rule for the Medicare hospital outpatient prospective payment system that revises policies that govern hospitals and other outpatient service providers in the 2007 calendar year. Most of the rule's provisions become effective January 1, 2007.

In this latest of the Medicare prospective payment system rules, CMS addresses:

  • How quality measures are to impact payment
  • Changes to the ambulatory payment classification (APC) groups and relative weights
  • An overhaul of the ambulatory surgical center payment process
  • Procedure movement between APCs
  • Clinical and emergency department coding changes
  • Policy modifications for drugs, radiopharmaceuticals, and blood products
  • Rural vs. other payment issues
  • Outlier policy changes
  • Partial hospitalization payments
Key areas this audio conference will cover include:
  • Overview of the new regulations
  • Rates for OPPS hospitals
  • Important changes to APCs
  • Changes to the copayment methodology
  • Payment issues related to devices, drugs, biologicals, partial hospitalization
  • Effects of outlier policy changes
  • Implementation of the Deficit Reduction Act provisions and impact on rural and other hospitals
  • Planning around the rule and "Medicare modernization"



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