CMS proposes ASC policy, payment changes for 2016: 8 things to know

Written by Carrie Pallardy | July 01, 2015 | Print  |

CMS has released its proposed policy and payment changes rule for the CY 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System.

Here are eight things to know about the OPPS/ASC proposed changes.

1. CMS proposes to update OPPS rates by -0.1 percent, based on a hospital market basket increase of 2.7 percent with a -0.6 percent adjustment for multi-factor productivity and a -0.2 percent point adjustment requirement by law. There is an additional -2 percent point adjustment aimed at addressing inflation in OPPS payment. Considering all policy changes, CMS estimates a -0.2 percent adjustment for hospitals paid under OPPS in CY 2016, according to the report.

2.  CMS also proposes restructuring, reorganizing and consolidating many OPPS Ambulatory Payment Classification groups. The proposal would result in fewer APCs for nine clinical APC families.

3. There are nine new Comprehensive Ambulatory Payment Classifications proposed for CY 2016. There are currently 25 C-APCs.

4.  ASC payments are updated on an annual basis based on the Consumer Price Index for all urban consumers. For CY 2016, CMS proposes a 1.7 percent CPI-U update. With a multi-factor productivity adjustment of 0.6 percent, the update is expected to be 1.1 percent.

5. CMS is proposing the removal of radiation treatment using Co-60 stereotactic radiosurgery from the list of ASC covered ancillary services.

6. CMS did not propose any new measures for the ASC Quality Reporting Program. The CY 2018 ASCQR Program includes 12 measures; 11 required and one voluntary.

7. Though CMS did not propose any new ASCQR Program measures, the agency did request comment on two measures for future consideration: Normothermia Outcome and Unplanned Anterior Vitrectomy.

8. CMS is accepting comments on the proposed rule until Aug. 31. The final rule is expected to be issued on or around Nov. 1.

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