Hosptial Outpatient Prospective Payment Proposed Rule Released for CY2017

On July 6, 2016 the Centers for Medicare and Medicaid Services (CMS) release the proposed rule for Hospital Outpatient Prospective Payment System (OPPS). For CY 2017, CMS is proposing to increase payment rates under the OPPS by 1.6 percent.
CMS proposes to create 25 new comprehensive ambulatory payment classifications (APCs) that meet previously established criteria bringing the total amount of C-APCS to 62 as of Jan. 1, 2017. These new C-APCs include nerve procedures, excision, biopsy, incision and drainage procedures, as well as airway endoscopy procedures.
CMS proposes extending the logic seen in the packaging of ancillary services, lab tests in 2014 and 2015, and applying that methodology to align all conditional packaging status indicators so packaging occurs at the claim level. CMS' proposal also includes:
  •  packaging based on claim instead of date of service;
  • an expansion of Molecular Pathology Laboratory test exception to include certain advanced diagnostic laboratory tests;
  • and discontinuation of the ‘L1' modifier.
Payment for Certain Items and Services Furnished by Certain Off-Campus Departments of a Provider:
CMS is implementing § 603 of the Bipartisan Budget Act of 2015 which requires that certain items furnished in off-campus provider departments will not be paid under the OPPS. Instead, services provided in off-campus provider departments would be paid under the same fee schedule prior to hospital acquisition.  
Hospital Value-Based Purchasing Program:
CMS proposes to remove Pain Management from the Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS beginning in 2018.  The proposal effectively delinks patient satisfaction and prescribing of opioid for pain management.  
To access a fact sheet on the proposed rule  click here
To view the proposed rule in its entirety click here