CMS Issues CY 2015 OPPS and ASC Final Rule

The Centers for Medicare & Medicaid Services (CMS) recently issued the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule with comment period for calendar year 2015.  The final rule implements changes to the payment rates for Medicare services paid under the OPPS and ACS payment system.  The final rule also updates the requirements for the Hospital Outpatient Quality Reporting Program and the ASC Quality Reporting Program.

Key highlights of the final rule include:

• Implementation of a policy relating to comprehensive Ambulatory Payment Classifications.
• Changes requiring physician certification only for long-stay (20 days or more) hospital inpatient admissions and outlier cases.
• Requirements for hospitals and physicians reporting services delivered in off-campus provider-based departments.
• Implementation of a process allowing CMS to recover overpayments resulting from erroneous payment data submitted by Medicare Advantage (MA) organizations or Part D prescription drug sponsors.
• Implementation of a three-step appeals process for MA organizations and part D prescription drug sponsors.

CMS is accepting comments on the final rule until December 30, 2014.  Most provisions of the rule are effective January 1, 2015.

The OPPS and ASC final rule is available at:

http://www.gpo.gov/fdsys/pkg/FR-2014-11-10/pdf/2014-26146.pdf.

The CMS fact sheet related to payment changes is available at:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-10-31.html.

The CMS fact sheet related to quality reporting changes is available at:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-10-31-2.html.

Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Physician-Owned Hospitals: Data Sources for Expansion Exception; Physician Certification of Inpatient Hospital Services; Medicare Advantage Organizations and Part D Sponsors: CMS-Identified Overpayments Associated with Submitted Payment Data; Final Rule, 79 Fed. Reg. 217, 66770, 66775 (Nov. 10, 2014).

Centers for Medicare & Medicaid Services.  “CMS Finalizes Hospital Outpatient and Ambulatory Surgical Centers Policy and Payment Changes for 2015.”  Fact Sheet.  31 Oct. 2014.

Centers for Medicare & Medicaid Services.  “CMS Finalizes Hospital Outpatient and Ambulatory Surgical Centers Quality Reporting Program Changes for 2015.”  Fact Sheet.  31 Oct. 2014.