This proposed rule would revise the Medicare hospital outpatient prospective payment system and the Medicare ambulatory surgical center payment system for CY 2015 to implement applicable statutory requirements and changes arising from continued experience with these systems. In this proposed rule is describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting Program and the ASC Quality Reporting Program.
In this document are proposed changes to the data sources used for expansion requests for physician owned hospitals under the physician self-referral regulations; changes to the physician certification requirements for hospital inpatient admissions to make the existing certification of the reason for hospitalization, the estimated time the patient will need to remain in the hospital, and the plan of post hospital care (if applicable), only applicable to long-stay cases and outlier cases; and changes to establish a three-level appeals process for Medicare Advantage (MA) organizations and Part D sponsors that would be applicable to CMS-identified overpayments associated with data submitted by these organizations and sponsors.
2015 OPPS NPRM Claims Accounting [PDF, 126KB]
2015 OPPS NPRM Cancer Adjustment Analysis File [ZIP, 240KB]
2015 OPPS NPRM Cost Statistics Files
2015 OPPS NPRM “Data Addendum B” and “2 Times Rule” File
2015 OPPS NPRM Facility-Specific Impacts
2015 OPPS NPRM Blood Revenue Code Cost to Charge Ratios
Proposed Changes to the Ambulatory Surgical Center Payment System and CY 2015 Payment Rates
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