2017 OPPS final rule: CMS expands comprehensive APCs, details site-neutral policy

Why This Topic Matters

The 2017 OPPS final rule introduced several payment and reporting changes that can affect outpatient reimbursement, claim submission workflows, and department-level billing practices. Understanding these updates helps hospitals and outpatient providers anticipate operational impacts and stay aligned with CMS policy.

Article Sections

1. Site-neutral payment policies and off-campus provider-based departments

   Summarizes CMS’s 2017 changes affecting off-campus provider-based hospital outpatient departments and related claim reporting practices. The section also addresses differences between excepted and non-excepted facilities and broader implications for outpatient payment policy.

2. C-APCs expanded

   Reviews the expansion of comprehensive APCs for 2017 and the resulting growth in procedures grouped under these payment categories. It also covers the related complexity-adjustment framework and updates tied to specific outpatient payment issues.

3. APC restructuring

   Describes CMS revisions to APC groupings for imaging services and new technology categories for 2017. The section focuses on how APC structure and status indicator assignments were updated under the final rule.

4. Device payment policy changes

   Covers CMS policy revisions for device-intensive procedures, device offset methodology, claim edits, and new reporting approaches for devices. It also discusses generic reporting options and payment methodology changes tied to device costs.

5. Payment rates

   Summarizes the 2017 OPPS payment update and related policy components that affect outpatient reimbursement levels. It also notes broader pricing and packaging adjustments discussed in the final rule.