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2013 OPPS Update
On November 15, 2012, the Centers for Medicare and Medicaid Services published the 2013 Outpatient Payment System (OPPS) Final Rule in the federal register. The rule finalizes payment rates and policies for outpatient services furnished by hospitals that are paid under the OPPS, and governs services provided on or after January 1, 2013.
The Facility Conversion Factor
For 2013, the conversion factor under OPPS will increase 1.8% from the 2012 value of $70.016 to yield a 2013 OPPS conversion factor of $71.313. As in prior years, CMS will apply a 2% penalty for hospitals not reporting outpatient quality measures, leading to a reduced conversion factor of $69.887 for those hospitals not meeting the Hospital Outpatient Quality Reporting (OQR) requirements.
ED Facility E/M Guidelines
For 2013, there will not be significant changes to the rules governing ED facility E/M guidelines. Per the initial description in the 2008 OPPS Final Rule, hospitals will be allowed to utilize their own scoring systems provided they accurately reflect facility resource utilization and are consistent with the eleven guiding principles published in the 2008 rule. Additionally, CMS reiterated its position related to the continuation of hospital-specific guidelines, and following a review of vigorous public commentary, states that it is not moving forward with a uniformly imposed set of national ED facility guidelines.
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