United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2004-09-17 monographic deposited born digital 39 p. GA 1.13:GAO-04-772 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-04-772 P0b002ee180380c91 f:d04772 DGPO 2010-08-12 2011-03-24 GAOREPORTS-GAO-04-772 machine generated eng fdlp REPORT GAOREPORTS-GAO-04-772 GAO-04-772 Cost analysis Drugs Health care costs Health care programs Health insurance Hospitals Insurance claims Medical services rates Payments Statistical methods Outpatient care services Medicare Hospital Outpatient Prospective Payment System Other Written Product A12410 Under the Medicare hospital outpatient prospective payment system (OPPS), hospitals receive a temporary additional payment for certain new drugs and devices while data on their costs are collected. In 2003, these payments expired for the first time for many drugs and devices. To incorporate these items into OPPS, the Centers for Medicare & Medicaid Services (CMS) used its rate-setting methodology that calculates costs from charges reported on claims by hospitals. At that time, some drug and device industry representatives noted that payment rates for many of these items decreased and were concerned that hospitals may limit beneficiary access to these items if they could not recover their costs. GAO was asked to examine whether the OPPS rate-setting methodology results in payment rates that uniformly reflect hospitals' costs for providing drugs and devices, and other outpatient services, and if it does not, to identify specific factors of the methodology that are problematic. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-04-772/html/GAOREPORTS-GAO-04-772.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-04-772/pdf/GAOREPORTS-GAO-04-772.pdf GAO-04-772 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-04-772 Other Written Product GAO-04-772; Medicare: Information Needed to Assess Adequacy of Rate-Setting Methodology for Payments for Hospital Outpatient Services; Cost analysis Drugs Health care costs Health care programs Health insurance Hospitals Insurance claims Medical services rates Payments Statistical methods Outpatient care services Medicare Hospital Outpatient Prospective Payment System Volume 111 Page 251 111 Stat. 251 Volume 113 Page 1501A-321 113 Stat. 1501A-321 Volume 117 Page 2066 117 Stat. 2066 Public Law 105-33 Public Law 106-113 Public Law 108-173