Outpatient Reimbursement: Get up to Speed on 2018 Final Rules for OPPS and MPFS

Why This Topic Matters

These final rule updates affect outpatient reimbursement, site-of-service policy, and operational planning for hospitals and related facilities. Understanding the scope of the changes helps organizations track payment impacts and evaluate whether they are affected by CMS’s policy revisions.

Article Sections

1. CMS Finalizes the Removal of TKA from IPO List

   This section covers CMS’s final OPPS decision on inpatient-only procedure status and the related payment context for the procedure discussed.

2. PHA and THA Still Under Consideration for Removal from IPO List

   This section summarizes CMS’s continued review of hip arthroplasty procedures and the range of stakeholder comments presented on the topic.

3. Definition of ASC-Covered Surgical Procedures Remains the Same

   This section discusses CMS’s approach to defining ASC-covered surgical procedures and the broader categories of services stakeholders wanted reconsidered.

4. Payment for 340B Drugs Drops to 22.5 Percent Less Than ASP

   This section addresses the 2018 OPPS drug payment adjustment and the categories of providers and products excluded from the change.

5. MPFS Finalizes Payment for Non-Excepted Off-Campus Departments

   This section explains the Medicare Physician Fee Schedule update for non-excepted off-campus departments and its effect on payment methodology.