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  • Final Rule On Outpatient Prospective Payment Includes 2.2% Rate Increase

    The final rule for the outpatient prospective payment system (OPPS), released by the Centers for Medicare and Medicaid Services (CMS) on October 31, includes a 2.2% increase in payment rates to hospital outpatient departments beginning January 1, 2015.

    The rule includes the packaging of payment for certain ancillary services provided in the hospital as well as comprehensive payments for a list of 25 primary services. The comprehensive payments include adjunctive services and supplies that support delivery of the primary service, which may include some physical therapist services that occur in the perioperative period. Further, the rule requires physician certification for hospital inpatient admissions only for long-stay cases and outlier cases, not short stays.

    Except for a small subset of ‘‘sometimes therapy’’ services delivered without a certified therapy plan of care, most physical therapist services provided in the outpatient hospital department are paid under the Medicare physician fee schedule (PFS), not the OPPS. CMS provides an annual update of these “sometimes therapy” services that are paid under the OPPS and subject to direct supervision requirements.

    A detailed summary of the rule will be available for APTA members in the coming weeks.

    Visit PT in Motion News for more information on recently released rules from CMS, including the 2015 physician fee schedule and home health prospective payment system.


    • What about private practice Outpatient not connected to a hospital system?

      Posted by Tina Grabill on 11/3/2014 10:49 AM

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