CMS Proposed Rule for Hospital Outpatient and ASC Payments

CMS Proposed Rule for Hospital Outpatient and ASC Payments. The Centers for Medicare & Medicaid Services on July 1 issued a proposed rule for calendar year 2016 for the hospital outpatient prospective payment (OPPS) and ambulatory surgical center (ASC) payment systems.

CMS proposes an OPPS decrease of 0.01%. The change is based on a projected hospital market basket increase of 2.7% percent minus a 0.6% adjustment for multifactor productivity and a 0.2% adjustment required by law. An additional 2% adjustment will be included to account for inflation in OPPS payments resulting from an increase in payments for laboratory tests that were previously paid under the Clinical Laboratory Fee Schedule.

Considering all policy changes, CMS estimates a -0.2% cut for hospitals paid under the OPPS in CY 2016.

In addition, CMS plans to reduce payments by 2.0% to hospital outpatient schedules that failed to meet the Hospital Outpatient Quality Reporting Program requirements. The agency also plans to reduce annual payment to ambulatory surgery centers by the same amount for failure to meet similar reporting requirements.

http://cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-01.html