CMS releases final 2009 OPPS rule, e-prescribing incentive program

CMS yesterday released its final rule for the outpatient prospective payment system (OPPS) in calendar year (CY) 2009, under which the agency will give providers a 3.6% annual inflation update and pay an estimated $30.1 billion in 2009 for outpatient services, up from an estimated $28.5 billion for CY 2008 (see related story in the July 7 Daily Briefing). Hospitals that do not meet quality reporting requirements, however, will receive a 1.6% inflation update.


In a news release, CMS notes the final rule increases the number of quality measures providers must report to receive the full payment inflation update from the current seven to 11, with the addition of four new measures for imaging efficiency. Additionally, the final rule establishes five imaging composite ambulatory payment classifications (APCs) to provide a single payment when providers perform multiple imaging procedures using the same modality in a single session. Specifically, the change will apply to certain ultrasound procedures, CT and CT angiography scans with or without contrast, and MRI and MRI angiography scans with or without contrast. The rule will be published in the Nov. 18 Federal Register.


Meanwhile, CMS yesterday also released its final 2009 physician fee schedule (PFS). In its final PFS rule, CMS details a new initiative designed to fuel physician adoption of electronic prescribing technology by allowing physicians and other eligible medical professionals who implement and use qualified e-prescribing systems to earn an incentive payment of 2% of their total Medicare-allowed charges during 2009. This incentive is in addition to the 2% incentive payment for 2009 for physicians who report measures under the Physician Quality Reporting Initiative (PQRI), as well as the 1.1% update required by the Medicare Improvements for Patients and Providers Act of 2008. Therefore, a physician participating in both the e-prescribing and PQRI initiatives could receive a payment boost of up to 5.1% for 2009. According to CMS, qualified e-prescribing systems must be able to communicate with the patient's pharmacy, help identify appropriate drugs and provide lower cost alternatives, provide information on formulary medications, and generate alerts on possible adverse events. Additionally, the rule reinstates the original computer-generated facsimile exemption that was adopted in the Nov. 7, 2005 final e-prescribing rule, effective Jan. 1, 2009. The final rule will appear in the Nov. 19 Federal Register.


(SOURCES: AHA News Now,, October 30, 2008; Advisory Board Daily Briefing,, October 31, 2008; Center for Medicare and Medicaid Services,, accessed November 2, 2008)