The 2016 OPPS Final Rule (effective January 1, 2016) is now available. Here’s the first paragraphs:
This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the 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 final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016.
In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.
Read this rule from the Federal Register (pdf) for November 13, 2015
- 2016 OPPS Final Rule Claims Accounting [PDF, 118KB]
- 2016 OPPS Final Rule Cancer Adjustment Analysis File [ZIP, 277KB]
Additional Resources
- CMS-1633-FC; CMS-1607-F2 (PDF) – Opens in a new window
- 2016 OPPS Final Rule Cost Statistics Files – Opens in a new window
- 2016 OPPS Final Rule “Data Addendum B” and “2 Times Rule” File – Opens in a new window
- 2016 OPPS Final Rule Addenda Table of Contents – Opens in a new window
- 2016 OPPS Final Rule Addenda – Opens in a new window
- 2016 OPPS Final Rule Facility-Specific Impacts – Opens in a new window
- 2016 OPPS Final Rule Blood Revenue Code Cost to Charge Ratios – Opens in a new window
- FY 2016 Wage Index Home Page
- Final Changes to the Ambulatory Surgical Center Payment System and CY 2016 Payment Rates