Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; physician-owned hospitals: data sources for expansion exception; physician certification of inpatient hospital services; Medicare Advantage organizations and Part D sponsors: CMS-identified overpayments associated with submitted payment data. Final rule with comment period.
Fed Regist. 2014 Nov 10; 79(217):66769-7034.FR

Abstract

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2015 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. In this document, we also are making changes to the data sources permitted for expansion requests for physician-owned hospitals under the physician self-referral regulations; changes to the underlying authority for the requirement of an admission order for all hospital inpatient admissions and changes to require physician certification for hospital inpatient admissions only for long-stay cases and outlier cases; and changes to establish a formal process, including a three-level appeals process, to recoup overpayments that result from the submission of erroneous payment data by Medicare Advantage (MA) organizations and Part D sponsors in the limited circumstances in which the organization or sponsor fails to correct these data.

Authors

Centers for Medicare & Medicaid Services (CMS), HHS

No affiliation info available

MeSH

CertificationHospitals, ProprietaryHumansMandatory ReportingMedicareMedicare Part CPhysician Self-ReferralProspective Payment SystemQuality of Health CareSurgicentersUnited States

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25387387

Citation

Centers for Medicare & Medicaid Services (CMS), HHS. "Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Physician-owned Hospitals: Data Sources for Expansion Exception; Physician Certification of Inpatient Hospital Services; Medicare Advantage Organizations and Part D Sponsors: CMS-identified Overpayments Associated With Submitted Payment Data. Final Rule With Comment Period." Federal Register, vol. 79, no. 217, 2014, pp. 66769-7034.

Centers for Medicare & Medicaid Services (CMS), HHS. Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; physician-owned hospitals: data sources for expansion exception; physician certification of inpatient hospital services; Medicare Advantage organizations and Part D sponsors: CMS-identified overpayments associated with submitted payment data. Final rule with comment period. Fed Regist. 2014;79(217):66769-7034.

Centers for Medicare & Medicaid Services (CMS), HHS. (2014). Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; physician-owned hospitals: data sources for expansion exception; physician certification of inpatient hospital services; Medicare Advantage organizations and Part D sponsors: CMS-identified overpayments associated with submitted payment data. Final rule with comment period. Federal Register, 79(217), 66769-7034.

Centers for Medicare & Medicaid Services (CMS), HHS. Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Physician-owned Hospitals: Data Sources for Expansion Exception; Physician Certification of Inpatient Hospital Services; Medicare Advantage Organizations and Part D Sponsors: CMS-identified Overpayments Associated With Submitted Payment Data. Final Rule With Comment Period. Fed Regist. 2014 Nov 10;79(217):66769-7034. PubMed PMID: 25387387.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; physician-owned hospitals: data sources for expansion exception; physician certification of inpatient hospital services; Medicare Advantage organizations and Part D sponsors: CMS-identified overpayments associated with submitted payment data. Final rule with comment period. A1 - ,, PY - 2014/11/13/entrez PY - 2014/11/13/pubmed PY - 2014/11/14/medline SP - 66769 EP - 7034 JF - Federal register JO - Fed Regist VL - 79 IS - 217 N2 - This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2015 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. In this document, we also are making changes to the data sources permitted for expansion requests for physician-owned hospitals under the physician self-referral regulations; changes to the underlying authority for the requirement of an admission order for all hospital inpatient admissions and changes to require physician certification for hospital inpatient admissions only for long-stay cases and outlier cases; and changes to establish a formal process, including a three-level appeals process, to recoup overpayments that result from the submission of erroneous payment data by Medicare Advantage (MA) organizations and Part D sponsors in the limited circumstances in which the organization or sponsor fails to correct these data. SN - 0097-6326 UR - https://www.unboundmedicine.com/medline/citation/25387387/Medicare_and_Medicaid_programs:_Hospital_Outpatient_Prospective_Payment_and_Ambulatory_Surgical_Center_Payment_Systems_and_Quality_Reporting_Programs DB - PRIME DP - Unbound Medicine ER -

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