Hospital
Outpatient Prospective Payment System (HOPPS)
T
The HOPPS payment rates increased by 1.9% on January 1st with CMS estimating 2012 payments
will total $41.1 billion for 4,000 hospitals, including general acute care
hospitals, inpatient rehabilitation facilities, inpatient psychiatric
facilities, long-term acute care hospitals, children's hospitals, and cancer
hospitals. Below are some highlights of these changes:- 2012 will see continued packaging of payment for services and agents in
seven categories into the reimbursement for the primary diagnostic or
therapeutic procedure; these are services and agents that CMS has deemed ancillary
to the primary procedure.
- 2012 CMS continues assignment of CPT codes 78459
(Myocardial imaging, positron emission tomography (PET), metabolic evaluation),
78491 (Myocardial imaging, positron emission tomography (PET), perfusion;
single study at rest or stress), and 78492 (Myocardial imaging, positron
emission tomography (PET), perfusion; multiple studies at rest and/or stress)
to APC 0307 (Myocardial Position Emission Tomography (PET) Imaging) which has a national unadjusted rate of $921
in 2012. This is a significant decrease from the 2011 national unadjusted rate of
$1,107; given that all diagnostic radiopharmaceuticals are packaged into the
APC for the related procedure, this decrease will have a negative impact on the
facilities offering these procedures
- Changes in to the physician supervision requirements were established by the
2012 HOPPS Final Rule - a delay in the enforcement of physician supervision
rules for critical access and small and rural hospitals with 100 beds or less
and the Federal Advisory Panel on Ambulatory Payment Classification Groups (APC
Panel) will begin review of supervision levels for all outpatient services,
starting as soon as early 2012.