The CMS issued its final rule on hospital outpatient payments for 2004, projecting a 4.5% aggregate increase in spending under the outpatient prospective payment system. In its proposed rule, the agency had projected a 3.8% aggregate increase. In another change, the final rule will create separate ambulatory payment classifications (APCs) for drugs and biologicals with a daily median cost of at least $50, while payments for drugs with a lower daily cost will be rolled into the APC for the primary procedure or treatment. The CMS initially proposed a $150 threshold. The final rule will be published in the Nov. 7 Federal Register and take effect Jan. 1. The agency also released its final rule for beneficiaries' appeals of Medicare decisions. An administrative law judge will review local coverage decisions. National coverage determinations by an administrative law judge will be reviewed by the HHS' appeals board. Appeals of the board's decisions will go to federal court. Read the outpatient payment rule on the CMS Web site. -- by Tony Fong
CMS releases final outpatient payment rule
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