CMS looks to enact site-neutral payment policies for off-campus departments in 2017 OPPS proposed rule

Why This Topic Matters

Hospitals and outpatient billing teams need to understand proposed OPPS changes that could alter reimbursement, billing workflows, and department status under Medicare. The article also highlights broader policy and reporting changes that may affect payment modeling, claims handling, and compliance planning.

Article Sections

1. Site-neutral payment proposal for off-campus provider-based departments

   Summarizes the proposed shift away from OPPS payment for certain off-campus provider-based departments and the operational issues raised for hospitals and physicians.

2. Excepted services and grandfathered status

   Describes which categories of services and locations may remain outside the new payment approach and discusses status-related considerations for existing facilities.

3. C-APCs

   Covers proposed updates to comprehensive APC policy, including new clinical families, additional APCs, and related service grouping changes.

4. Allogeneic stem cell transplantation payment changes

   Discusses proposed changes tied to stem cell transplant payment methodology, hospital reporting, and related cost reporting updates.

5. Complexity adjustment changes

   Explains proposed revisions to the logic used for certain APC complexity adjustments and the scope of code combinations affected.

6. Payment rates

   Reviews the proposed OPPS update percentage, related adjustments, estimated payment impact, and timing for comments and finalization.