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2015 CMS Hospital Outpatient Fee Schedule Final Regulations for EDs and Trauma Centers Are Out, Packaging of Ancillary Services Among Changes

The Centers for Medicare and Medicaid Services (CMS) recently released the final rules for the 2015 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates. The final rules have several changes from the draft rules (which were released in July of this year) and these changes can have a significant impact on the bottom line of EDs and trauma centers.

While CMS currently pays separately for ancillary services, including in emergency departments (EDs) and trauma centers, it has finalized expanded packaging of all ancillary services assigned to APCs. When these ancillary services are furnished by themselves, CMS proposes to make separate payments for these services only, a potentially significant financial impact on providers.

Additionally, CMS has decided to implement comprehensive ambulatory payment classifications (C-APCs), meaning that providers will get paid a sum for those outpatient services which are heavily dependent on devices. CMS had initially proposed 28 comprehensive APCs, however, they have decided to finalize only 25 of them. CMS has also decided to bundle payments among other important changes in the final rules.

The final rule is now available in the Federal Register and can be downloaded here. The provisions in the rule will generally take effect on January 1, 2015. The public comment period will close on December 30, 2014.

Having trouble understanding all of the changes to the OPPS Fee Schedule? Want to develop strategies to maximize revenue? Join The Abaris Group on December 11th as we discuss the 2015 final CMS OPPS and Physician Fee Schedule during our webinar: CMS 2015 Final Rules for Payments to Hospitals/Trauma Centers. Click here to register.

View the final Hospital OPPS Fact Sheet here and rule here.

By Mike Williams, President – The Abaris Group

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