Compliance

Services (CMS) released the final rules for calendar year (CY) 2025 Hospital Outpatient Prospective Payment System (HOPPS). 1 For HOPPS, the main highlight is the proposed increase in payments for CY 2025 and adjustments related to hospital extensions and waivers from the publich health emergency (PHE) ending. HOPPS Payment RatesCMS used the CY 2023 claims data for rate setting for CY 2025, which follows the usual 2-year difference in data for rate setting due to allowance for 1 year of timely filing for billing.CMS finalized a 2.9% increase to the outpatient department (OPD) fee schedule.Based on the market update from the Inpatient Prospective Payment System (IPPS) of 3.4% and a 0.5% productivity adjustment decrease, this results in a final conversion factor (CF) of $89.169 for hospitals that meet the Hospital Outpatient Quality Reporting (OQR) requirements; applying the 2% reduction to those that do not, the CF is $87.439.CMS estimates total payments to HOPPS providers will be approximately $87.7 billion, an increase of approximately $4.7 billion compared