However, the CMS Office of the Actuary (OACT) found that about $1 billion in laboratory tests payments that were projected to be packaged into OPPS payment rates continued to be paid separately in CY 2014. Specifically, CMS estimated that its policy to classify laboratory services as packaged would result in a $2.4 billion shift in CY 2014 OPPS spending for laboratory tests previously paid at the Clinical Laboratory Fee Schedule payment rates outside the OPPS. After all other policy changes finalized under the OPPS, including estimated spending for pass-through payments, CMS estimates a -0.4 percent change in spending (before taking into account changes in volume and case mix) for hospitals paid under the OPPS in CY 2016.īeneficiary co-insurance for OPPS services is projected to decrease from 19.9 percent in CY 2015 to 19.3 percent in CY 2016.ĬMS finalized a proposal to reduce the CY 2016 conversion factor to account for approximately $1 billion in inflation in the OPPS payments resulting from excess packaged payment under the OPPS. The final rate update will be -0.3 percent. As described below, there is an additional finalized 2.0 percentage point adjustment to the payment update to redress inflation in the OPPS payment rates resulting from excess packaged payment for laboratory tests that continue to be paid separately outside of the OPPS. The OPPS/ASC final rule is one of several rules for CY 2016 that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.ĬMS is updating OPPS rates based on the projected hospital market basket increase of 2.4 percent minus both a 0.5 percentage point adjustment for multi-factor productivity and a 0.2 percentage point adjustment required by law. See the related fact sheet for detailed information. The final rule also includes important changes to the Two Midnight Rule effective beginning in CY 2016. OPPS payment amounts vary according to the Ambulatory Payment Classification (APC) group to which a service or procedure is assigned. The OPPS provides payment for most HOPD services, including partial hospitalization services furnished by HOPDs and CMHCs. Approximately 4,000 hospitals and 60 CMHCs are paid under the OPPS, while approximately 5,300 ASCs are paid under the ASC payment system. The CY 2016 OPPS/ASC final rule updates Medicare payment policies and rates for hospital outpatient departments (HOPDs), ASCs, and partial hospitalization services provided by community mental health centers (CMHCs), and refinements to programs that encourage high-quality care in these outpatient settings. The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates final rule with comment period (OPPS/ASC final rule) on October 30, 2015. CMS Finalizes Hospital Outpatient and Ambulatory Surgical Center Policy and Payment Changes, Including Changes to the Two-Midnight Rule and Quality Reporting for 2016
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