Hospital Outpatient and Ambulatory Surgical Center Policy and Payment Changes

cmsNewLogo-squareThe Centers for Medicare & Medicaid Services 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) [CMS-1633-FC] on October 30, 2015.

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. 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 OPPS provides payment for most HOPD services, including partial hospitalization services furnished by HOPDs and CMHCs. OPPS payment amounts vary according to the Ambulatory Payment Classification (APC) group to which a service or procedure is assigned. The final rule also includes important changes to the Two Midnight Rule effective beginning in CY 2016. See the related fact sheet for detailed information.

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Fact Sheet: Two-Midnight Rule
In addition, On October 30, 2015, CMS released updates to the Two-Midnight rule regarding when inpatient admissions are appropriate for payment under Medicare Part A. These changes continue CMS’ long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries. These updates were included in the calendar year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) final rule.

Click here to read more Two-Midnight Rule fact sheet.