{"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.","action":"Final rule with comment period.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2014/11/10/2014-26146.html","cfr_references":[{"chapter":null,"citation_url":null,"part":411,"title":42},{"chapter":null,"citation_url":null,"part":412,"title":42},{"chapter":null,"citation_url":null,"part":416,"title":42},{"chapter":null,"citation_url":null,"part":419,"title":42},{"chapter":null,"citation_url":null,"part":422,"title":42},{"chapter":null,"citation_url":null,"part":423,"title":42},{"chapter":null,"citation_url":null,"part":424,"title":42}],"citation":"79 FR 66770","comment_url":null,"comments_close_on":"2014-12-30","correction_of":null,"corrections":[],"dates":"Effective Date: This final rule with comment period is effective on January 1, 2015.","disposition_notes":null,"docket_ids":["CMS-1613-FC"],"dockets":[],"document_number":"2014-26146","effective_on":"2015-01-01","end_page":67034,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2014/11/10/2014-26146.xml","html_url":"https://www.federalregister.gov/documents/2014/11/10/2014-26146/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2014-26146?publication_date=2014-11-10","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2014-11-10/2014-26146/mods.xml","not_received_for_publication":null,"page_length":265,"page_views":{"count":28613,"last_updated":"2026-10-23 18:15:05 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2014-11-10/pdf/2014-26146.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2014-26146.pdf?1414787533","publication_date":"2014-11-10","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2014/11/10/2014-26146.txt","regulation_id_number_info":{"0938-AS15":{"issue":"201404","html_url":"https://www.federalregister.gov/regulations/0938-AS15/cy-2015-hospital-outpatient-prospective-payment-system-pps-policy-changes-and-payment-rates-and-cy-2","title":"CY 2015 Hospital Outpatient Prospective Payment System (PPS) Policy Changes and Payment Rates, and CY 2015 Ambulatory Surgical Center Payment System Policy Changes and Payment Rates (CMS-1613-P)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201404&RIN=0938-AS15&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AS15"],"regulations_dot_gov_info":{"supporting_documents":[],"comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS-2014-0093","supporting_documents_count":0,"docket_id":"CMS-2014-0093","regulation_id_number":null,"title":"CY 2015 Proposed Changes to the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Physician Self-Referrals; Provider Claim Appeals for Medicare Parts C and D CMS-1613-P","checked_regulationsdotgov_at":"2015-01-12T19:17:32Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":66770,"subtype":null,"title":"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","toc_doc":"Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs, etc.; Physician-Owned Hospitals; Part D Sponsors","toc_subject":"Medicare and Medicaid Programs:","topics":["Administrative practice and procedure","Emergency medical services","Health facilities","Health maintenance organizations (HMO)","Health professions","Hospitals","Kidney diseases","Medicare","Penalties","Privacy","Puerto Rico","Reporting and recordkeeping requirements"],"type":"Rule","volume":79}