Under the final rule, the amount beneficiaries will pay for outpatient services will continue to decline based on a formula in the Medicare law that is designed to provide a gradual transition to 20 percent coinsurance for all APCs. Prior to implementing the OPPS in CY 2000, beneficiaries were responsible for 20 percent of the hospital's charges, rather than 20 percent of the Medicare payment rate, for outpatient services. Because hospital charges rose faster over time than Medicare payment rates for these services, the beneficiary share often exceeded 50 percent of the total amount collected by the hospital for the service. CMS estimates that nearly 25 percent of all types of services furnished in HOPDs, reflecting 85 percent of all billed services, will be subject to the 20 percent coinsurance rate in CY 2009.

The final rule with comment will appear in the November 18 Federal Register. Comments on designated provisions are due by 5:00 p.m. Eastern time on December 29, 2008, and a final rule responding to the comments will be published at a later date.


For more information on the CY 2009 final rule with comment period for the OPPS and ASC payment system, please see the CMS Web site at:

OPPS: http://www.cms.hhs.gov/HospitalOutpatientPPS/

ASC payment system: www.cms.hhs.gov/ASCPayment/

ASC conditions for coverage: www.cms.hhs.gov/CFCsAndCoPs/16_ASC.asp#TopOfPage

Also, please see the Fact Sheets posted on the CMS Web site at: www.cms.hhs.gov/apps/media/fact_sheets.asp.

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