CMS Released the Proposed Outpatient Prospective Payment Rule for 2023

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  • CMS proposed changes to determine payment rates for Medicare services paid under the OPPS and ASC payment system for CY by 2.7%.  
  • CMS estimates that total payments to OPPS and ASC providers for CY 2023 will be approximately $86.2B and $5.4B, respectively.  
  • Formal comments on the rule are accepted until September 13, 2022.  

CMS (Centers for Medicare & Medicaid Services) issued the Calendar Year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.  

This proposed rule describes the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and the ASC payment system. CMS is proposing to update OPPS and ASC payment rates for CY 2023 by 2.7%.  

These updates are based on the projected hospital market basket percentage increase of 3.1% reduced by 0.4% point for the productivity adjustment.  

Based on the proposed policies, CMS estimates that total payments to OPPS and ASC providers for CY 2023 will be approximately $86.2 billion and $5.4 billion, respectively. These total payments include beneficiary cost-sharing and estimated changes in enrollment, utilization, and case-mix. 

This represents an increase of approximately $6.2 billion and an increase of $130 million, respectively, from CY 2022 payment amounts.  

Some key proposals of this payment rule are: 
  •  Updating OPPS and ASC payment rates by 2.7% for facilities meeting quality reporting requirements.  
  • Establishing provider enrollment procedures and payment rates for rural emergency hospitals.  
  • Exempting rural Sole Community Hospitals from the clinic visit payment policy.  
  • Requesting information about enhancing transparency and competition in the healthcare system. 
  • Removing 10 services from the inpatient only (IPO) list next year. The procedures were removed from the list in 2021 as part of the first phase of eliminating the IPO list, but they were added back to the list when the elimination process was halted last year.  

Also, this CMS rule proposes to update and refine the requirements for:  

  • The Hospital Outpatient Quality Reporting (OQR) Program. 
  • The ASC Quality Reporting (ASCQR) Program. 
  • The Rural Emergency Hospital Quality Reporting (REH) Program.  

The document also proposes updates to the requirements for organ acquisition, rural emergency hospitals, prior authorization, and overall hospital quality star rating. 

Read more about this proposed outpatient prospective payment rule on this CMS fact sheet. CMS encourages stakeholders to review the rule and submit formal comments on the rule by September 13, 2022.  

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