Home 5 News 5 CMS Hikes 2023 Medicare OPPS Reimbursement Rate 3.8 Percent

CMS Hikes 2023 Medicare OPPS Reimbursement Rate 3.8 Percent

by | Nov 9, 2022 | News

However, the increase still isn’t enough to keep pace with inflation, providers contend.

The Centers for Medicare & Medicaid Services (CMS) final Outpatient Prospective Payment System Final Rule for 2023 (OPPS Rule) published on Nov. 1 provides a rate increase of 3.8 percent on Medicare services to hospital and ambulatory surgical center (ASC) outpatients. The rate increase follows the productivity-adjusted hospital market basket update to payment rates that the agency adopted in 2019 for use through calendar year (CY) 2023. The CY 2023 calculation is based on the following factors:

  • Projected hospital market basket percentage increase is 4.1 percent (as opposed to just 2.7 percent in CY 2022); minus
  • The Affordable Care Act (ACA)-required multifactor productivity adjustment of -0.3 percent (which was -0.7 percent last year).

The overall 3.8 percent increase contained in the final OPPS Rule represents a bit of a victory for hospitals and ASCs given that the proposed rule included only a 3.1 percent increase to the market basket rate. The American Hospital Association (AHA) and other provider groups objected that the method used to calculate the market basket rate, which is designed to estimate the costs of goods and services providers are expected to incur in the coming year, didn’t adequately capture the impacts of inflation. CMS ultimately agreed and increased the market basket rate another 1.0 percent to 4.1 percent. 

However, the AHA contends that the increase is still not enough to keep pace with inflation “given the extraordinary cost pressures hospitals face from labor, supplies, equipment, drugs and other expenses,” according to a statement from AHA executive vice president Stacey Hughes. “Hospitals are still dealing with a wide range of challenges in providing care,” Hughes added, “which is why the AHA is urging Congress for additional support by the end of the year.”

For a more in-depth report, check out this article from our upcoming December 2022 issue of National Lab Reporter, posted in advance of PDF publication.

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