CMS proposes massive APC reconfiguration, updates 2-midnight rule

Why This Topic Matters

The proposed changes could materially affect outpatient payment structure, claim-level reimbursement, and review processes for providers. Readers responsible for coding, charge capture, revenue cycle, and compliance will want to understand which outpatient services may be affected and what operational preparation may be needed.

Article Sections

1. APC reconfiguration

   Discusses CMS proposals to reorganize outpatient payment categories across multiple clinical families and to revise APC numbering and structure. The section also notes where proposed crosswalk and addendum resources are used to review the changes.

2. New C-APCs

   Summarizes the proposed additions to comprehensive APCs and the broader observation-related framework discussed in the rule. It also covers the proposed reporting and claim-level implications tied to the expanded C-APC program.

3. 2-midnight rule update

   Reviews the proposed outpatient discussion of short-stay inpatient admissions, medical review, and the shifting role of QIO entities in review activities. The section describes the policy direction and oversight framework at a high level.

4. Additional 2016 OPPS changes proposed by CMS

   Covers other proposed outpatient payment policy changes beyond APC restructuring, including discontinued procedure payment adjustments and inpatient-only list movement. It also notes related status indicator proposals for selected procedures.