On February 24, 2015, CMS published corrections to the hospital outpatient prospective payment system (OPPS) and the ambulatory surgical center (ASC) payment system Final Rule that was published in the November 10, 2014 Federal Register. 

OPPS corrections:  CMS incorporated certain outlier payments that were inadvertently omitted from the calculations of the target payment-to-cost ratio (PCR) and the estimated PCR for the OPPS cancer hospital payment adjustment, which resulted in a decrease in CMS’s estimate of total cancer hospital payments by $18.6 million.   This decrease in estimated payments to cancer hospitals has resulted in a budget neutrality adjustment, increasing the OPPS conversion factor from $74.144 to $74.173, which will slightly increase payment rates for most ambulatory payment classifications (APCs).

ASC Payment System corrections:  For some items, such as device-intensive procedures, the ASC payment rates also take into account the OPPS conversion factor and payment  rates.  Thus, the OPPS conversion factor and payment rate adjustments described above also impacted ASC payment rates.  Also, the transitional wage index for CY 2015 was calculated incorrectly in the Final Rule.  Due to these corrections, the final CY 2015 ASC wage index budget neutrality adjustment has decreased from 0.9998 to 0.9995.  The final CY 2015 ASC conversion factor has been updated from $44.071 to $44.058, and for ASCs that do not meet the requirements of the ASC Quality Reporting Program, from $43.202 to $43.189.  Also, corrections to the final CY 2015 Medicare Physician Fee Schedule (MPFS) rates (Federal Register notice to be published soon) have impacted the final CY 2015 ASC rates and payment indicators for certain office-based covered surgical procedures and certain covered ancillary services.

In addition to the highlights summarized above, the Corrections Notice also includes certain other technical corrections.  A copy of the Corrections Notice is available by clicking here.

Reporter, Susan Banks, Washington, D.C., +1 202 626 2953, sbanks@kslaw.com.