US · guidance
CMS Pub. 100-04, ch. 4, § 10.6.2.4
Application of the Payment Reduction Factor in Calculation
of the Reduced Payment and Reduced Copayment
(Rev. 1657, Issued: 12-31-08, Effective: 01-01-09, Implementation: 01-05-09)
For services to which the payment adjustment applies, CMS calculates a payment
reduction factor that is used in the OPPS Pricer to adjust the payments for hospitals that
fail to meet the reporting requirements. CMS calculates this factor by dividing the
OPPS conversion factor that incorporates the reduced update factor by the OPPS
conversion factor that incorporates the full update factor for the applicable
calendar year. This ratio is applied to the full national unadjusted payment amount for a
service subject to the payment reduction in order to calculate the reduced payment
amount. Similarly, this ratio is applied to the full national unadjusted copayment for an
applicable service to calculate the reduced copayment that may be collected from the
beneficiary by the hospital. The payment reduction factor will be included in the annual
OPPS update change request and may also be found in the applicable OPPS final rule,
which can be found at www.cms.hhs.gov/HospitalOutpatientPPS/ under “Hospital
Outpatient Regulations and Notices”.
History
(Rev. 1657, Issued: 12-31-08, Effective: 01-01-09, Implementation: 01-05-09)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a2c7b1eef1e3dcac1866e0cf7895d253a38319b246a8d59d46f241e4d348d501
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