Hospital Outpatient Prospective Payment Changes Finalized by CMS for 2017

On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Ambulatory Surgical Center (ASC) Payment system and Hospital Outpatient Prospective Payment System (OPPS) quality provisions, policy changes and payment rates final rule with comment period (CMS-1656-FC) for 2017 calendar year (CY). A large number of ASC and OPPS policies are being finalized by the CMS which will provide better quality of care that Medicare patients receive.

Moreover, an Interim Final Rule with comment period (IFC) was issued by CMS in order to implement Medicare Physician Fee Schedule (MPFS) rates for some services and items furnished by few off-campus outpatient departments of a provider to address the changes required by Bipartisan Budget Act of 2015 in Section 603.

The comments made by health care providers on the patient experience survey regarding pain management was addressed by CMS. It is currently finalizing the removal of the Pain Management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for requirement of the Hospital Value Based Purchasing Program.

OPPS – Payment Update

OPPS rates have been updated by 1.65% by the CMS for CY 2017. The basis of change is due to the projected hospital market basket increase of 2.7% minus both a 0.3 percentage point adjustment for multi-factor productivity (MFP) and a 0.75% adjustment needed by law. After analyzing every other policy changes created under the OPPS, which includes estimated spending for pass-through payments, a 1.7% payment increase is estimated by the CMS (before taking into account changes in case mix and volume) for hospitals paid under the OPPS in CY 2017.

Inpatient Only List

The procedures which are paid only under the IPPS are included in the Medicare inpatient-only (IPO) list. An established criteria is used by CMS every year to review the IPO list and ascertain whether any procedures need to be removed from the list. Seven procedures from the IPO list are being removed by the CMS for CY 2017. The procedures consist of five spine procedures along with two laryngoplasty procedures. The OPPS/ASC final rule for CY 2017 with comment period also consist of responses to a comment solicitation concerning whether total knee arthroplasty (TKA) needs to be removed from the IPO list in the following year. All these comments will be considered by the CMO in future policy making.

For more on Medicare updates coming your way in 2017 join a live audio conference by expert speaker Jill M. Young. This session will provide attendees with an overview of sedation changes in endoscopy procedures, as well as the latest HCPCS/CPT coding changes. You will also be able to gain insights on Supervision levels for incident to work for care management codes.

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