decisionhealth Newsletters, Part B News - 2017 Issue 11 (November)
2018 OPPS final rule: CMS to cut 340B drug program payments by 22.5%
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Article Overview
This article reviews CMS’s 2018 OPPS final rule with emphasis on Medicare outpatient payment changes tied to the 340B drug discount program and related packaging policies. It is intended for hospital outpatient coders, revenue cycle staff, compliance teams, and other professionals tracking OPPS policy updates, litigation risk, and operational reporting requirements. The discussion covers the payment methodology change, modifier-based reporting, exempt provider categories, and conditional packaging of certain drug administration services.
Why This Topic Matters
The rule affects how hospitals and outpatient providers report and receive payment for certain drugs and drug administration services under OPPS. It also highlights operational reporting changes and policy shifts that may influence billing workflows, compliance planning, and future payment adjustments.
Article Sections
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340B drug payment policy under the 2018 OPPS final rule
Discusses the OPPS policy update affecting outpatient drug payment methodology and the broader context of CMS’s final rule. It also addresses stakeholder response and the budget-neutral redistribution concept at a high level.
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Modifier-based reporting and provider categories
Covers the reporting approach CMS uses for identifying affected drugs, along with the provider categories and drug types discussed in the rule. It also notes operational timing considerations raised in the article.
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Packaging of drug administration services
Summarizes the final rule’s treatment of selected outpatient drug administration services and the related packaging discussion. It mentions the broader policy direction without detailing code-specific guidance.
What You Will Learn
- How the 2018 OPPS final rule changes the general payment framework for certain outpatient drugs
- What types of reporting and modifier-related updates the article discusses
- Which outpatient drug administration services are addressed in the final rule
- How the article frames CMS’s policy rationale and stakeholder concerns
- What operational issues hospitals may need to consider under the updated OPPS policy
Who Should Read This
- Hospital outpatient coders
- Revenue cycle managers
- Compliance professionals
- Health system finance teams
- OPPS policy analysts
Codes Discussed
Modifiers Discussed
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