OPPS Final Rule Update: Good News: Your ED Facility Levels Get a Reprieve

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews a 2014 outpatient prospective payment system update that addresses hospital emergency department facility levels and outpatient clinic visit payment methodology. It is aimed at hospital coders, billing staff, and emergency medicine leaders who need to understand how CMS structured the final rule for facility-level reimbursement and how the change compares across service settings.

Why This Topic Matters

The article matters because it highlights a Medicare outpatient payment update that affects hospital facility reimbursement, especially for emergency departments and outpatient clinics. It helps readers understand the broader policy shift and the operational impact on facility-level visit payment structures.

Article Sections

  1. OPPS Final Rule Overview

    Introduces the outpatient payment update and frames the discussion around hospital facility reimbursement changes for the coming year.

  2. Emergency Department Facility Levels Remain at Five

    Discusses the status of emergency department facility-level structure under the final rule and its relationship to hospital outpatient reimbursement.

  3. Outpatient Clinic Visits Move to a Single Payment Level

    Summarizes the clinic visit payment methodology change under OPPS and the broader implications for facility-based outpatient services.

  4. CMS Rationale for Different Treatment of Clinic and ED Visits

    Describes the policy reasoning CMS used when comparing outpatient clinic visits with emergency department visit structures in the final rule.

What You Will Learn

  • How the 2014 OPPS final rule affects hospital outpatient reimbursement
  • How emergency department facility levels are addressed in the final rule
  • How outpatient clinic visit payment methodology is structured under the update
  • What CMS emphasized when comparing clinic visits and emergency department visits

Who Should Read This

  • Hospital coders
  • Outpatient billing staff
  • Emergency department revenue cycle professionals
  • Hospital compliance teams
  • Emergency medicine administrators

Codes Discussed


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