HOPPS Effective Date Delay
ALS Member Update: January 9, 2002

On December 31, 2001, the Centers for Medicare and Medicaid Services ("CMS") announced a delay in the effective date of the 2002 Hospital Outpatient Prospective Payment System ("HOPPS") rates for a period of up to three months. It is expected that the 2002 HOPPS rates will become effective on April 1, 2002. Without the delay, the 2002 HOPPS rates would have become effective on January 1, 2002.

As described in an earlier ALS Member Update, CMS announced that it would delay implementation of the 2002 HOPPS rates until April 1, but all reimbursement in 2002 would have been at the 2002 HOPPS rates. It is reported that CMS received Congressional pressure to rescind that policy. Clearly, CMS's current determination to delay the effective date rescinds its previous policy.

During the effective date delay, hospitals will be permitted to charge 2001 HOPPS rates during the 2002 HOPPS rates delay. Accordingly, CMS will reimburse hospitals for lithotripsy provided in an outpatient setting during the effective date delay period at the rate of $2,347.25, subject to increases or decreases in certain locations based on the applicable geographic wage index. Once the 2002 HOPPS rates are effective, lithotripsy provided in an outpatient setting will be reimbursed at the rate of $2,016.82, a decrease of $330.43 from the 2001 HOPPS rate.

It is important to note that under HOPPS a Medicare beneficiary's copayment liability may not exceed the hospital inpatient deductible applicable to the given year. For calendar year 2002, a Medicare beneficiary's hospital inpatient deductible is $812.00. Under HOPPS, the National Unadjusted Coinsurance rate for the provision of lithotripsy in an outpatient setting during the effective date delay and after the effective date delay would exceed the inpatient deductible. Accordingly, during the calendar year 2002, a Medicare beneficiary's copayment liability for the provision of lithotripsy in a hospital outpatient setting is limited to $812.00.

If you have any questions concerning this Member Update, please contact the Executive Director of the American Lithotripsy Society, Wes Harrington at the ALS Headquarters in Waltham, Massachusetts. Watch the ALS Website / Governmental Affairs Updates / for more information regarding this situation in the weeks ahead.

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Visit us again to receive up-to-the-minute reports on major issues such as the Health Care Finance Administration's (HCFA) proposed implementation of the Stark II (Physician Ownership) regulations and HCFA's proposed rates for lithotripsy performed in/out patient and ambulatory surgical center settings.

For additional information contact, Wesley E. Harrington, CAE, Executive Director of ALS at:
American Lithotripsy Society, 305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088

E-mail: als@lithotripsy.org


American Lithotripsy Society
305 Second Avenue, Suite 200
Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088
email:
als@lithotripsy.org


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