Hospital Outpatient Prospective Payment System

The Hospital Outpatient Prospective Payment System (HOPPS) is used by the Centers for Medicare and Medicaid Services (CMS) to reimburse for hospital outpatient services. CMS created HOPPS to reduce beneficiary copayments in response to rapidly growing Medicare expenditures for outpatient services and large copayments being made by Medicare beneficiaries.

All covered outpatient services belong to an Ambulatory Payment Classification (APC) group. Each group of procedure (i.e., codes) within an APC is supposed to be “similar clinically and with regard to resource consumption.”

Background


Below we provide several background documents about HOPPS

Hospital Outpatient Prospective Payment System Rule


Below we provide detailed summaries for recent proposed HOPPS rules.

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