Medicare Finalizes Payment Updates for Outpatient Hospital Departments for 2024

Outpatient hospital departments (OPDs) will receive a 3.1% payment update in calendar year (CY) 2024 as outlined in the outpatient prospective payment system (OPPS) final rule released November 2. The Centers for Medicare & Medicaid Services (CMS) estimates that payments to OPDs will be $88.9 billion, an increase of $6 billion from 2023. The policies of this final rule are applicable to services provided on or after January 1, 2024.

The policies are of particular interest to audiologists in OPDs as their services are typically paid through the OPPS based on Ambulatory Payment Classifications (APCs). However, speech-language pathology services are typically paid through the Medicare Physician Fee Schedule (MPFS) and not the OPPS. ASHA submitted comments on the OPPS proposed rule [PDF] earlier this year.

Hospital Outpatient Quality Reporting Program (OQRP)

CMS modified several measures already included in the OQRP effective for the 2024 reporting/2026 payment year including the:

• COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure;
• Cataracts: Improvement in Patient’s Visual Function Within 90 Days Following Cataract Surgery measure; and
• Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients measure.

It also adopted several new measures for the OQRP including the:

• Risk-Standardized Patient-Reported Outcome-Based Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) in the Hospital Outpatient Department (HOPD) Setting (THA/TKA PRO-PM) with voluntary reporting in CY 2025 through CY 2027 followed by mandatory reporting beginning with the CY 2028 reporting period/CY 2031 payment determination; and
• Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Hospital Level – Outpatient) measure with voluntary reporting beginning in CY 2025 and mandatory reporting beginning with the CY 2027 reporting period/CY 2029 payment determination.

Hospital Price Transparency

CMS made several updates to its hospital price transparency requirements to improve its monitoring and enforcement capabilities in ways CMS believes will (1) improve access to, and the usability of, hospital standard charge information and (2) reduce the compliance burden on hospitals. Among the numerous modifications finalized, hospitals will use a standardized template to submit this data to CMS. ASHA has historically supported price transparency initiatives in an effort to ensure patients can make informed health care choices but has stressed that such initiatives need to minimize provider burden to the extent practicable.

Resources

CMS provides extensive information on the OPPS, including payment rates for Current Procedural Terminology (CPT®) codes by APC, on its website. For more information on Medicare Part B services paid under the MPFS, see ASHA’s resources on Medicare Payment for Outpatient Audiology and Speech-Language Pathology Services.

Questions?

Please contact ASHA’s health care and education policy team at reimbursement@asha.org.