OPPS Update: Expect to See More Bundling with Overall Lower Payments in 2016

Why This Topic Matters

The article helps readers understand how the 2016 OPPS final rule may change outpatient reimbursement, packaging, and reporting patterns for common hospital services. This is important for organizations that code and bill clinic, ED, observation, critical care, and related outpatient encounters under Medicare.

Article Sections

1. OPPS Final Rule Overview and Payment Update

   Introduces the 2016 OPPS final rule, effective date, and the overall direction of Medicare outpatient payment changes. Summarizes the broad payment update context for hospitals and outpatient departments.

2. Outpatient Visit Level Guidelines

   Reviews continuing clinic and emergency department visit coding policies for 2016. Covers the general categories of facility visit reporting discussed in the article.

3. Renumbered Clinic Visits APCs

   Describes changes to the clinic visit ambulatory payment classification structure and the related payment update. Also notes the continuation of the current facility clinic visit framework.

4. Critical Care APC Payment Increases, but Not with Trauma Activation

   Summarizes the article’s discussion of critical care payment updates and trauma activation payment changes. Includes related packaging considerations for ancillary services on the same date of service.

5. New Status Indicator for Observation APC

   Explains the observation comprehensive APC update, including the new APC structure and status indicator discussion. Covers the broader observation claim categories and packaging approach described in the article.

6. Two-Midnight Rule Will Continue to Define Observation vs. Inpatient Stays

   Reviews the article’s discussion of the two-midnight policy and related exceptions. Also covers the compliance and review context described for inpatient versus observation stays.

7. Chronic Care Management and Advanced Care Planning Pay

   Summarizes the article’s discussion of outpatient payment treatment for chronic care management and advance care planning services. Notes the general conditions and packaging context addressed in the article.