CMS Proposes 2015 ASC, HOPD & Physician Fee Schedule Payment Changes: 5 Things to Know

The Centers for Medicare and Medicaid Services has proposed 2015 payment changes for hospital outpatient departments and ambulatory surgery centers, as well as policy and payment changes for the Medicare Physician Fee Schedule. Here are five things to know about the proposed changes.

1. The proposed changes are designed to shift the Outpatient Prospective Payment System from a hybrid system and fee schedule to a more complete prospective payment system, according to the CMS report. There are more than 4,000 hospitals and 5,300 Medicare-certified ASCs paid under the OPPS. OPPS payment amounts vary based on the Ambulatory Payment Classification group to which each service or procedure is assigned.

2. CMS proposed to update the OPPS market basket by 2.1 percent for the calendar year 2015. This increase is based on projected hospital market basket increase of 2.7 percent minus both a 0.4 percent adjustment for multi-factor productivity and a 0.2 percent adjustment required by law.

3. ASC payments are updated each year to account for inflation by the percentage increase in the Consumer Price Index for all urban consumers. Medicare also specifies a multi-factor productivity adjustment to the ASC annual update. The Consumer Price Index update is projected to be 1.7 percent and the multifactor productivity adjustment is projected to be 0.5 percent for CY 2015. The MFP-adjusted CPI-U update would be 1.2 percent for CY 2015.

4. The proposed changes to the Medicare Physician Fee Schedule would establish payment rates that are more transparent and allow for more public input before rates are set. Through the new process, payment changes will go through notice and comment before adoption in 2016. The proposed changes would also include anesthesia under the definition of screening colonoscopy, eliminating the need for Medicare beneficiaries to pay co-insurance on the anesthesia portion of the procedure.

5.  CMS will accept comments on the proposed changes until Sept. 2. The final rule for ASC and HOPD payments will be issued on or around Nov. 1.

Read the full proposed changes for HOPD and ASC payment rates and the Medicare Physician Fee Schedule.

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