CHA News Article

CMS Issues CY 2015 OPPS, PFS Final Rules

The Centers for Medicare & Medicaid Services (CMS) has issued the attached calendar year (CY) 2015 outpatient prospective payment system (OPPS) final rule. Overall OPPS payments are estimated to increase by 2.3 percent for CY 2015, or approximately $900 million compared to CY 2014. CMS finalized its proposal to establish comprehensive ambulatory payment classifications (C-APCs) for 25 of the 28 proposed C-APCs. CMS also finalized its proposal to collect data on services furnished in off-campus provider-based departments by requiring hospitals to report a modifier for those. In addition, CMS finalized updates to the hospital outpatient quality reporting (OQR) program, including the addition of one measure for FY 2018; the exclusion of a previously adopted measure from the measure set for the CY 2016 payment determination to become a voluntary measure for CY 2017; the removal of two topped-out measures; and changes to data submission and collection requirements for other measures. CMS has provided separate fact sheets for the payment and policy provisions and the quality provisions. CHA is reviewing the rule and will provide a detailed summary in the coming weeks.

CMS also issued its final rule updating the physician fee schedule (PFS) for CY 2015. The Protecting Access to Medicare Act of 2014 required a zero percent update to the PFS, along with adjustments necessary to maintain budget neutrality. Absent further congressional action, a Medicare sustainable growth rate-induced reduction of about 20.9 percent in the conversion would occur on April 1, 2015. CHA will provide additional detail on the attached rule in a future summary.