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CMS Releases CY 2015 HOPPS & MPFS Final Rules

October 31, 2014

On Friday, October 31, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2015 Final Rules for the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule. The public comment period will close for both rules on December 30, 2014.

The HOPPS rule updates Medicare payment policies and rates for hospital outpatient department and ambulatory surgical center services. In CY 2015, HOPPS payments are estimated to increase by 2.3 percent.   The increase is based on the projected hospital market basket increase of 2.9 percent minus both a 0.5 percentage point adjustment for multi-factor productivity and a 0.2 percentage point adjustment required by law and includes other payment changes, such as increased estimated total outlier payments. CMS has also adopted a C-APC payment policy, which is an APC with a high cost primary service (generally includes the implantation of a device) that accounts for a higher percentage of the total costs of the hospital encounter.

The MPFS rule pays for covered physicians’ services furnished to a person with Medicare Part B. In the final rule, CMS has adopted a new process for establishing payment rates that will be more transparent and allow for greater public input prior to payment rates being set. Under the new process beginning with 2017, public comments will be considered for the vast majority of payment changes before they take effect. The final rule also makes some changes to quality reporting initiatives such as the Physician Quality Reporting System (PQRS). Finally, the rule continues the phased-in implementation of the physician value-based payment modifier (Value Modifier), created by the Affordable Care Act, that would affect payments to physicians and physician groups, as well as other eligible professionals, based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare fee-for-service program.

The CY 2015 Hospital Outpatient Prospective Payment System Final Rule can be found here.

The CY 2015 Medicare Physician Fee Schedule Final Rule can be found here.