CMS releases final OPPS 2017 rule

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On November 1, the U.S. Centers for Medicare and Medicaid Services (CMS) released its final 2017 rule for the Hospital Outpatient Prospective Payment System (OPPS), confirming proposals outlined in the July version.

The final rule will increase OPPS payments by 1.7%. In addition, it finalizes a provision on site-neutral payments that CMS proposed, which states that new off-campus sites that provide items and services to outpatients will be paid based on the Medicare Physician Fee Schedule (MPFS) technical component rate rather than under the Hospital OPPS. The move is an attempt to level the playing field, CMS said.

"Currently, Medicare pays for the same services at a higher rate if those services are provided in a hospital outpatient department rather than a physician's office," the agency wrote. "This payment differential has provided an incentive for hospitals to acquire physician offices in order to receive the higher rates."

But this could negatively affect some imaging services, according to Kathryn Keysor, the American College of Radiology's (ACR) director of economics and health policy.

"We're concerned about cuts to MRI services as a result of changes in the Hospital OPPS," she told "The ACR will do a detailed current procedural terminology (CPT) code-level analysis to determine the specific impacts over the coming weeks."

Incentive program updates

The OPPS rule extends into 2017 a 90-day electronic health record (EHR) reporting period established this year for all eligible professionals and hospitals that have previously demonstrated meaningful use in the Medicare and Medicaid Electronic Health Record Incentive Programs. It also eliminates the clinical decision-support (CDS) and computerized provider order-entry (CPOE) objectives for eligible hospitals under the Medicare EHR Incentive Program for modified stage 2 and stage 3 for 2017 and subsequent years in an effort to reduce reporting burden, CMS said.

CMS confirmed that it will offer a "hardship exception" from the 2018 payment adjustment for new 2017 EHR incentive program participants who are transitioning to the Merit-Based Incentive Payment System (MIPS).

Finally, the rule creates an additional 25 new comprehensive ambulatory payment classifications (C-APCs), bringing the total number to 62 as of January 1, 2017. Many of these new C-APCs are major surgery codes within the various existing C-APC clinical families, but CMS is also adding three new clinical families to accommodate new C-APCs: nerve procedures; excision, biopsy, incision, and drainage procedures; and airway endoscopy procedures, the agency said.

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