Medicare Payment and Reimbursement

CY16 OPPS Final Rule Fact Sheet

December 28, 2015 4:22 pm

CMS released a final rule with comment period revising the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY16 to implement certain applicable statutory requirements and changes. In this final rule, CMS describes the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and the ASC payment system. The final rule also updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, as well as the ASC Quality Reporting (ASCQR) Program. Further, the rule also includes certain finalized policies relating to the hospital inpatient prospective payment system (IPPS), including changes to the two-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 (OMB) delineations in FY15 and have not reclassified from urban to rural before Jan. 1, 2016. The rule 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.

Download the fact sheet 

 

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