CMS Releases Proposed 2015 Hospital Outpatient Payment Rates: 7 Things to Know

CMS has released proposed changes to Medicare's Hospital Outpatient Prospective Payment System for calendar year 2015. Here are seven things to know about the Hospital OPPS and the proposed rule.

1. More than 4,000 hospitals receive reimbursement through the OPPS, which provides payment for most hospital outpatient department services and partial hospitalization services administered by hospital outpatient departments and community mental health centers. OPPS rates vary depending on Ambulatory Payment Classification groups for procedures and services.

2. CMS has proposed updating the OPPS market basket by 2.1 percent in 2015. That overall increase reflects a projected hospital market basket increase of 2.7 percent, minus a 0.4 percentage point multi-factor productivity adjustment and a 0.2 percentage point adjustment required by law.

3. The proposed rule for 2015 includes additional comprehensive ambulatory payment classifications. Comprehensive-APCs were created to pay for high-cost device-dependent services using a single payment for a hospital stay in 29 device-dependent APCs. A comprehensive-APC policy meant to expand the items and services packaged into a single payment for a comprehensive primary care service was included in a final rule for calendar year 2014, CMS delayed implementation by a year to give the agency and hospitals more time to evaluate and comment on the policy.

4. For 2015, CMS has proposed conditional packaging of all ancillary services — which are integral, supporting or adjunctive to a primary service — assigned to APCs with a geometric mean cost of $100 or less.

5. Under the proposed rule, CMS would also collect data on services provided in off-campus provider-based departments. Starting in 2015, hospitals and physicians would have to report a modifier for services furnished in these settings.

6. Under the rule, CMS would also maintain the community mental health center outlier payments threshold at 3.4 times the highest CMHC Partial Hospitalization Program APC payment rate.

7. CMS has also proposed that for hospitals to receive outlier payments under the PPS, the cost of the service administered must be more than the multiple threshold of 1.75 times the APC payment rate and exceed the 2015 fixed dollar threshold of the APC payment, plus $3,100.

For more information, view the full proposed rule here. CMS will accept comments on the rule until Sept. 2.

More Articles on Medicare Payments:
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CMS Proposes Home Health Medicare Payment Changes: 4 Things to Know
UnitedHealth Consultant Aims to Fix Medicare Reimbursement 


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