Under the old law, coinsurance is based on 20 percent of the hospital’s billed charges. OPPS freezes coinsurance at 20 percent of the national median charge for the services within each APC (wage adjusted for the provider’s geographic area). However, coinsurance for an APC cannot be less than 20 percent of the APC payment rate, and the wage adjusted coinsurance amount cannot exceed inpatient deductible amount.

Hospitals have the option of election to reduce coinsurance payments and advertise their reduced rates for all OPPS services. You may elect to receive a coinsurance payment from Medicare beneficiaries that is less than the wage adjusted coinsurance amount per APC. This coinsurance amount must be offered to all Medicare beneficiaries.

You must file the APC Coinsurance Election Form using the following instructions:

• Review the list of APCs and their respective coinsurance amounts in the Federal Register issued for that calendar year.
• Adjust those coinsurance amounts using the wage index applicable to your Metropolitan Statistical Area (MSA). Providers approved for geographic reclassifications to another MSA for wage index should use the reclassified wage index.
• Decide which APCs, if any, you elect to reduce coinsurance for.
• Notify Empire Medicare Services (EMS) of your election by December 1st prior to the calendar year you wish to elect reduced coinsurance for, using the attached form.