CMS Issues 2007 Proposed Hospital Outpatient Prospective Payment System (HOPPS) Rule

August 11, 2006

CMS Issues 2007 Proposed Hospital Outpatient Prospective Payment System (HOPPS) Rule

On August 8, 2006, the Centers for Medicare & Medicaid Services (CMS) posted an advanced notice of the hospital outpatient prospective payment system (OPPS) proposed rule for calendar year (CY) 2007. In addition to proposing policy and payment changes for services furnished to Medicare beneficiaries in hospital outpatient departments, the rule also includes: a CY 2007 Update to the Ambulatory Surgical Center Covered Procedures List; the Ambulatory Surgical Center Payment System and CY 2008 Payment rates; Medicare Administrative Contractor (MAC) updates; and Reporting Hospital Quality Data for FY 2008 Inpatient Prospective Payment System Annual Payment Update Program. These expanded measures have been endorsed by the Hospital Quality Alliance (HQA), a privately led collaborative effort to support measuring and improving the quality of care in hospitals, and have been endorsed through the National Quality Forum’s public consensus process.

Other important proposed changes for CY 2007 affecting nuclear medicine in the rule include:

  • Increasing the $50 threshold to $55 for drugs and radiopharmaceuticals that will be separately paid
  • CMS is proposing to eliminate the current Cost to Charge (CCR) payment methodology for radiopharmaceuticals
    • Payment for radiopharmaceuticals with a per day cost greater than $55 is proposed to be based on the mean cost calculated using hospital claims
  • Several nuclear medicine APCs are proposed to transition out of New Technology and into Nuclear Medicine APCs
    • This resulted in significant reductions in PET and PET/CT. CMS plans to use hospital claims data from 2005 for payment calculations.

The SNM prepares charts and spreadsheets that evaluate the impact of the proposed HOPPS rule for nuclear medicine procedures and products. Please look for the updated charts early next week (August 14) on the SNM Coding Corner.

The Proposed 2007 HOPPS Rule can be found on the CMS website at: http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage.
The press release issued by CMS on the rule can be found at: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1938.