CMS Releases Hospital OPPS and ASC Proposed Rule for CY 2015.

Date posted: August 6, 2014

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for Hospital Outpatient Prospective Payment System and Ambulatory Surgical Centers (ASCs) for calendar year 2015.  The proposed rule updates Medicare payment policies and rates, and streamlines programs that promote high quality care in outpatient department and ASC settings.

Key highlights of the proposed rule include:

  • Propose a process for overpayment recovery and appeals for Medicare Parts C and D;
  • Require a modifier for physicians’ services and outpatient hospital services provided in an off-campus provider-based department of a hospital;
  • Revise the physician certification requirements so that certification for inpatient admission is required only for long term stays (20 days or more) or outlier cases; and
  • Propose quality program changes to the hospital outpatient quality reporting program validation process.

CMS is accepting comments on the proposed rule until September 2, 2014.


The proposed rule is available at:

http://www.gpo.gov/fdsys/pkg/FR-2014-07-14/pdf/2014-15939.pdf.

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

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-07-03-4.html.

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

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-07-03-5.html?DLPage=1&DLSort=0&DLSortDir=descending.

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: Appeals Process for Overpayments Associated With Submitted Data;Proposed Rule, 79 Fed. Reg. 134 40916 (July 14, 2014).

Centers for Medicare & Medicaid Services.  “CMS Proposes Hospital Outpatient and Ambulatory Surgical Centers Policy and Payment Changes for 2015.”  Fact Sheet.  3 Jul. 2014.

Centers for Medicare & Medicaid Services.  “CMS Proposes Hospital Outpatient and Ambulatory Surgical Centers Quality Changes for 2015.”  Fact Sheet.  3 Jul. 2014.

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