November 6, 2014

CMS Issues Final Medicare Rules for CY2015

CMS has released the display version of the final outpatient prospective payment system (OPPS) rule for calendar year 2015. The rule will be published in the Federal Register on Nov. 10. Most proposed changes were adopted as final.

The major components of the final rule are as follows:

The final CY2015 OPPS market basket and Patient Protection and Affordable Care Act (PPACA) offsets are 2.9 percent and -0.7 percent, respectively, for a net update factor of 2.2 percent.
The final CY2015 OPPS national conversion factor is $74.144 - a 2.0 percent increase over the final CY2014 rate. This is 0.1 percent lower than the amount published in the proposed rule and is due to budget neutrality adjustment.
The final CY2015 OPPS wage indexes will be the same as for the final FY2015 inpatient PPS.
The final CY2015 OPPS outlier threshold is $2,775, which is lower than the 2014 threshold and lower than the proposed threshold.
The rural sole community hospital add-on is retained at 7.1 percent.
CMS has made some modest revisions to the Comprehensive Ambulatory Payment Classifications (C-APCs), eliminating three of the proposed 28 C-APCs (now 25) and modifying the complexity adjustment criteria. The C-APC payment policy allows a single payment for all related hospital items and services provided to a patient receiving certain device-dependent procedures, such as insertion of a pacemaker, rather than separate payments for each supportive service, such as routine tests and diagnostic procedures.
CMS will package all ancillary services assigned to APCs with a mean cost of less than $100.
CMS will no longer require physician certification of the medical necessity of inpatient services for all inpatient admissions under the two-midnight rule. CMS will require a physician certification for outlier cases and long-stay cases of 20 days or more. CMS will continue to require a signed physician admission order when a patient has been formally admitted as an inpatient of the hospital.
CMS finalized its proposal to collect data on services provided in off-campus provider-based departments. Data collection is voluntary in 2015 for hospitals and required as of January 2016.
CMS has also issued final rules for CY2015 for home health, ambulatory surgical centers, the physician fee schedule, and dialysis providers. FHA will provide detailed summaries of these rules in the coming weeks, as well as hospital-specific impact analyses of the outpatient and home health PPS final rules.

For more information, contact Kathy Reep, vice president of financial services, at (407) 841-6230.