2016 OPPS Rule Changes

2016 OPPSRule ChangesMaggie Fortin, CPC, CPC-H, CHCS enior ManagerJanet Hodgdon, CPA, CPCD irectorDecember 2015 OPPS -Talking points2 CMS Objectives-Incentivize efficient care-Reduce administrative burden for more accuracy of payment Achieve long-term goal to create a single prospective payment for the entire outpatient encounter by packaging payment for all C APC servicesALSO:Statutory reduction for failure to meet quality reporting of 2%Wage index to be used will be final IPPSOVERALL DECREASE IN PAYMENTS ESTIMATED AT $133 MILLIONM arket Productivity(.5)%ACA(.2)%Packaged lab issue( )%Overall update(.3)%Final Payment UpdatesSCH rural adjustment for outpatient continues at , biologicals and radio-pharmaceuticals are set at the ASP plus 6%Other Updates and AdjustmentsOPPS Operational Updates5 OPPSIn the 2016 OPPS rule change we continue to see CMS implementing Changes to this ever-evolving complex payment system CMS continues to revise the packaging "of items and services to make the system more prospectiveRework: Composite APC logicAddition to the new C-APC listMovement of certain APC weightsReclassification of current APC groupsChanges and additions to APC status indicators62016 Comprehensive APCC omprehensive APC definition: a primary service payment inclusive of integral, supportive, dependent and adjunctive services and items provided to support the delivery of the primary serviceThis newest APC category recognizes an additional 10 clinical groups in 2016 Compreh

2016 OPPS Rule Changes Maggie Fortin, CPC, CPC -H, CHC Senior Manager Janet Hodgdon, CPA, CPC Director December 2015

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