CMS finalizes 2024 OPPS final rule: 4 must-know updates

On Nov. 2, CMS finalized the calendar year 2024 Medicare Outpatient Prospective Payment System final rule. The 2024 OPPS final rule includes policies that will:

• add 10 services to the Inpatient Only list;
• establish an intensive outpatient program;
• expand the partial hospitalization program rate structure;
• update payment rates and policies for ambulatory surgical centers;
• update the requirements for the Hospital Outpatient Quality Reporting Program;
• outline quality program requirements for Rural Emergency Hospitals; and
• standardize the reporting of standard chart data using a CMS template.

Read on to learn essential OPPS final rule information, important details and dates. We’ll also reveal how you can register for DataGen’s upcoming client exclusive OPPS rule analysis webinar.

4 key CMS 2024 OPPS final rule components

1. Expanded and updated rates

CMS estimates a 2.1% rate increase for CY 2024, which represents a $6 billion increase in outpatient payments compared to the CY 2023 OPPS final rule.

2024 OPPS final rule changes include new and expanded reimbursement for mental health services and ambulatory surgery centers.

2. New services and programs

As lines between inpatient and outpatient care blur, CMS continues to define care that Medicare will only reimburse in an inpatient setting. For CY 2024, CMS added 10 new services and procedures to the Inpatient Only list, including vertebral body tethering; select cardiac diagnostics (ultrasounds) and treatments (valve implants or replacements); and select cranial procedures (neurotransmitter implants, craniectomy and craniotomy).

To expand covered mental health treatment options, the OPPS rule includes intensive outpatient program services in CY 2024. An IOP is less intensive than a partial hospitalization program, and multiple providers can deliver services in addition to hospitals: community mental health centers, federally qualified health centers and rural health clinics.

3. Quality program changes and additions

The CY 2024 OPPS final rule includes CMS’ annual updates to its Hospital Outpatient Quality Reporting Program. CMS designed the Hospital OQR to help improve the quality and safety of Medicare outpatient services, assisting its larger effort to support value-based care.

Program changes

COVID-19 vaccinations, cataract surgery outcomes and colonoscopies will start at age 45 for average-risk patients.

New additions

Two new Hospital OQR program measures address patient-reported outcomes after elective outpatient care. This includes total hip and/or knee arthroplasty and CT radiation dosage and image quality.

Quality reporting expansion includes the creation of the Rural Emergency Hospital Quality Reporting program, a new reimbursable provider type as of Jan. 1, 2023. The first REHQR measures will include:

• Abdomen Computed Tomography – Use of Contrast Material;
• Median Time from ED Arrival to ED Departure for Discharged ED Patients;
• Facility Seven-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy; and
• Risk-Standardized Hospital Visits within Seven Days After Hospital Outpatient Surgery.

Measure outcomes will appear on Care Compare.

4. Price transparency standards

As part of the 2024 OPPS final rule, CMS will standardize several hospital price transparency requirements to improve monitoring and enforcement. It will also reduce hospitals’ compliance burden. CMS has updated the required standard charge information and data elements that hospitals must submit and provided a new template. Its Hospital Price Transparency Fact Sheet details these changes further.

Upcoming 2024 OPPS final rule dates

Watch for these upcoming dates related to the CY 2024 OPPS final rule:

• Dec. 5, 2023: Join DataGen’s OPPS rule analysis webinar for national clients and hospitals, 3 - 4 p.m. EST. 
• Jan. 1, 2024: This is the comment due date for new service level status indicator assignments. Take advantage of a final OPPS rule comment opportunity at Regulations.gov (rule number CMS-1786–FC).

Need help calculating the final rule’s impact?

Want a better grasp on how your facility’s revenue and margins will be impacted? DataGen analyzes major rule components with a special focus on those that impact reimbursement. Our insights help providers educate key stakeholders and plan changes to payment and workflow, easily allowing you to compare the differences between CMS’ 2023 and 2024 OPPS final rules (and so much more!).

Streamline your impact analysis and contact us today for a consultation.