CMS looks to align packaging logic in 2017 OPPS proposed rule

Why This Topic Matters

These proposed OPPS changes can affect claim packaging, payment status, modifier reporting, and hospital billing workflows across outpatient and ancillary services. The article is relevant for organizations tracking CMS rulemaking and preparing for updates that may alter reimbursement and reporting requirements.

Article Sections

1. Packaging logic changes

   Discusses proposed OPPS packaging updates for conditional packaging and related claim-level behavior. It also addresses CMS’s rationale for revising how outpatient hospital services are grouped for payment.

2. Laboratory test packaging and modifier updates

   Covers proposed changes to laboratory test packaging, including exceptions for certain test categories. It also discusses the planned removal of a modifier associated with separately reportable laboratory testing and the broader policy context behind that change.

3. Device-intensive procedures

   Reviews CMS’s proposed methodology for identifying device-intensive procedures and the related payment approach. It also notes updates affecting device pass-through payment calculations and claims-based data requirements.

4. Inpatient-only list

   Summarizes proposed removals from the inpatient-only list for the 2017 cycle. The section identifies the procedure groups affected without detailing how each code would be handled.

5. X-ray modifier

   Explains the proposed requirement for a modifier tied to certain X-ray imaging payment reductions under federal law. It also notes the timing and broader implementation framework discussed by CMS.