CMS estimates it will pay $39 billion to hospitals, $4 billion to ASCs in 2011

December 16, 2010

CMS expects to pay $39 billion to hospitals and $4 billion to ASC for outpatient services provided in 2011.

The Centers for Medicare and Medicaid Services (CMS) expects to pay $39 billion to hospitals and $4 billion to ambulatory surgical centers (ASC) for outpatient services provided in 2011. 

CMS released a preview of its final rule for Hospital Outpatient Prospective Payment System (OPPS) in the Federal Register (http://edocket.access.gpo.gov/2010/pdf/2010-27926.pdf) in late November.

CMS is also proposing to allocate $200 million in estimated drug costs to hospital pharmacy overhead expenses. Calendar year 2010 was the first year that CMS included in the reimbursement calculation the estimated pharmacy overhead costs for drugs separately payable from the ambulatory payment classification (APC) groups.

As a result, hospitals must declare procedural codes for all drugs, whether they are APC-packaged or separately payable, on all claims submitted to the agency.

The rule also increases reimbursements to hospitals for separately payable drugs in 2011 from the average sales price (ASP) plus 5%, up from ASP plus 4% in 2010.